Extremism

Yvette Cooper: (Urgent Question): To ask the Home Secretary to make a statement on her conduct regarding the Government’s action on preventing extremism.

Theresa May: The Government take the threat of extremism—non-violent extremism as well as violent extremism—very seriously. That is why, in line with the Prime Minister’s Munich speech in 2011, I reformed the Prevent strategy that year, and it is why, in response to the killing of Drummer Lee Rigby, the Prime Minister established the extremism taskforce last year.
	The Prevent strategy we inherited was deeply flawed. It confused Government policy to promote integration with Government policy to prevent terrorism. It failed to tackle the extremist ideology that undermines the cohesion of our society and inspires would-be terrorists to murder. In trying to reach those at risk of radicalisation, funding sometimes reached the very extremist organisations that Prevent should have been confronting. Ministers and officials sometimes engaged with, and therefore leant legitimacy to, organisations and people with extremist agendas.
	Unlike the old strategy, this Government’s Prevent strategy recognises and tackles the danger of non-violent extremism as well as violent extremism. Unlike the old strategy, the new strategy addresses all forms of extremism. Unlike the old strategy, there is now a clear demarcation between counter-terrorism work, which is run out of the Home Office, and the Government’s wider counter-extremist and integration work, which is co-ordinated by the Department for Communities and Local Government. Unlike the old strategy, the new strategy introduced explicit controls to make sure that public money must not be provided to extremist organisations. If organisations do not support the values of democracy, human rights, equality before the law and participation in society, we should not work with them and we should not fund them.
	Turning to the issue of the unauthorised comments to the media about the Government’s approach to tackling extremism and the improper release of correspondence between Ministers, the Cabinet Secretary undertook a review to establish the facts of what happened last week. As the Cabinet Secretary and Prime Minister concluded, I did not authorise the release of my letter to the Education Secretary. Following the Cabinet Secretary’s review, the Education Secretary apologised
	to the Prime Minister and to Charles Farr, the director general of the office for security and counter-terrorism. In addition, in relation to further comments to
	The Times
	, my special adviser Fiona Cunningham resigned on Saturday.

Yvette Cooper: The Education Secretary will shortly make a statement about Birmingham schools, but last week the Home Secretary and the Education Secretary turned this instead into a public blame game about the Government’s approach to tackling extremism. There are important questions about the oversight and management of these schools, which the House will debate shortly. There are also real and separate concerns about the Government’s failure to work with communities on preventing extremism and about the narrowness of the Home Secretary’s approach.
	Both issues are complex and require a thoughtful, sensitive approach and for Ministers to work together, just as Departments, communities, parents, local councils and the police need to do. Instead of showing leadership on working together, the Home Secretary and Education Secretary chose to let rip at each other in public, making it harder to get the sensible joint working we need. That is why the Home Secretary needs to answer specific questions about her conduct in this process, particularly about the letter she wrote to the Education Secretary, which the Home Office released and which has made it harder to get that joint working in place.
	The Home Secretary has said that she did not authorise the publication of the letter on the Home Office website, but why did she not insist that it be removed, rather than leaving it in place on the website for three days? She wrote that letter and sent it after she had been advised that The Times newspaper had briefing from the Education Secretary. Did she write that letter in order for it to be leaked, and did she authorise its release to the media? Section 2.1 of the “Ministerial Code” makes it clear that
	“the privacy of opinions expressed in Cabinet and Ministerial Committees, including in correspondence, should be maintained.”
	Did she and her Department breach the “Ministerial Code”?
	Secondly, the Home Secretary made it clear in her letter that she disagreed with the Education Secretary’s approach. She said:
	“The allegations relating to schools in Birmingham raise serious questions about the quality of school governance and oversight arrangements in the maintained sector”.
	Does she stand by her claim that the oversight arrangements for Birmingham schools under the Education Secretary were not adequate?
	Thirdly, the Home Secretary’s strategy on preventing extremism has been criticised from all sides—not just by the Education Secretary—for failing to engage with local communities and for having become too narrow, leaving gaps. She now needs to focus on getting those policies back on track, because it matters to communities across the country that there is a serious and sensible approach to these issues and joint working at the very top of the Government.
	The reason why the Home Secretary needs to answer these questions about her decisions last week is to assure us that she and the Education Secretary will not put their personal reputations and ambitions ahead of
	making the right decisions for the country. We cannot have a repeat of the experiences of last week. It is shambolic for the Government, but it is much worse for everyone else.

Theresa May: On the specific allegations of extremism in schools in Birmingham and the wider question of how we confront extremism more generally, there are very important issues that I will come on to, but I should perhaps first remind the shadow Home Secretary of a few facts.
	Under this Government, foreign hate preachers such as Zakir Naik and Yusuf al-Qaradawi are banned from coming to Britain. Under her Government, they were allowed to come here to give lectures and sermons, and to spread their hateful beliefs. In the case of al-Qaradawi, he was not just allowed to come here; he was literally embraced on stage by Labour’s London Mayor, Ken Livingstone.
	I have excluded more foreign hate preachers than any Home Secretary before me. I have got rid of the likes of Abu Hamza and Abu Qatada. The Government do not give a public platform to groups that condone, or fail to distance themselves from, extremism. For the first time, we are mapping out extremists and extremist groups in the United Kingdom. We make sure that the groups we work with and fund adhere to British values, and where they do not, we do not fund them and we do not work with them. None of these things was true when the Labour party was in power.
	The shadow Home Secretary asked about the “Ministerial Code”. I can tell her that, as the Cabinet Secretary and the Prime Minister concluded, I did not break the code. As she has no evidence for suggesting I did, she should withdraw any allegation of that sort.
	The right hon. Lady asked about the letter, its presence on the website and why action was not taken, but action was taken immediately, because the Prime Minister asked the Cabinet Secretary to investigate, and he did.
	The right hon. Lady referred to schools in Birmingham. I am afraid she will have to wait for my right hon. Friend the Education Secretary to make his statement; he will do so shortly, and answer questions about school inspections and oversight arrangements.
	I would just say this to the right hon. Lady: I am responsible for the Government’s counter-terrorism strategy and, within that, the Prevent strategy, but she seems to misunderstand how the Prevent strategy works, so I think I should perhaps explain it to her. The Home Office sets the Prevent strategy and it is up to the rest of Whitehall, including the Home Office, as well as the wider public sector and civil society, to deliver it. There is always more to be done, things we can improve and lessons we can learn, but we have made good progress under this Government. Yes, we need to get to the bottom of what has happened in schools in Birmingham, but it is thanks to this Education Secretary that the Department for Education has, for the first time, a dedicated extremism unit to try to stop this sort of thing happening.
	The shadow Home Secretary repeated her complaint that Prevent has become too narrowly drawn under this Government, but she does not seem to realise that we
	took a very clear decision back in 2011 to split Prevent into the bit that tackles non-violent extremism as well as violent extremism and counter-terrorism, and the Government’s integration strategy, which is quite consciously run out of the Department for Communities and Local Government. If what she is suggesting is that Prevent and integration work should go back to being together and being confused, she needs to think again because her Government’s approach was damaging and caused a lot of resentment among many British Muslims.
	As the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), the former Home Secretary, said at the time we made that change, it follows
	“the eminently sensible objective of keeping the ‘prevent’ strand of counter-terrorism separate from the ‘integration’ initiatives of DCLG.”
	He continued:
	“I completely agree with what the Home Secretary has said about Prevent.”—[Official Report, 14 July 2010; Vol. 513, c. 1011.]
	The shadow Home Secretary should listen to her right honourable colleague.
	What has happened in Birmingham is very serious indeed, and the Education Secretary will set out his response in due course. We need to do everything we can to protect children from extremism and, more generally, to confront extremism in all its forms. The Government are determined to do that. However, it is quite clear from what the shadow Home Secretary has said today that on extremism, like on so many other things, the Labour party would take us backwards, not forwards.

Mark Harper: I am very pleased that the Home Secretary focused on the substance, rather than on the pointless process questions that the shadow Home Secretary focused on. I welcome what the Home Secretary said about the changes to Prevent. Is it not better to have our approach, rather than the last Government’s? The Communities and Local Government Committee said that the Labour Government’s Prevent strategy was wasting money
	“on unfocused or irrelevant projects”.

Theresa May: I agree completely with my hon. Friend. That was an early decision by this Government. It was absolutely right to separate the two strands of work of the Prevent strategy: the counter-terrorism work and the integration work. It is right that the integration work is now under the remit of the DCLG. I repeat what I said in my response to the shadow Home Secretary: I suggest that Labour Members listen to the words of the right hon. Member for Kingston upon Hull West and Hessle in this respect. He agreed absolutely with what the Government have done.

David Blunkett: The Home Secretary is at her worst when she seeks to patronise. These are extraordinarily difficult and sensitive issues, and they are certainly not funny. Whether we agree or disagree about the previous Prevent strategy, what measures do she and the Education Secretary together intend to take to reach out to the Muslim community in Britain and engage them in a positive dialogue, to ensure that we do not sink into a strategy of “They did it, we did it, other people have
	done it and therefore we are against you,” which can only lead to divisions in our urban communities and great dangers for our country?

Theresa May: Across the Government, we are absolutely clear that we need to reach out to and work with people in Muslim communities in the United Kingdom to ensure that we address the real issues of potential radicalisation and extremism, which many people in those communities are as concerned about as we are. That work is led by the DCLG through its work on integration at a local level. It is also work that we, as constituency Members of Parliament, can take forward. Last Friday, I was talking with a group of Asian women from my constituency about their experiences, what they wanted to do and how they wanted to work with the local council and others to ensure that people in Muslim communities feel able to be true to their Islamic faith and play a full part in British society.

Julian Huppert: There are many issues on which the Home Office has to work with the Department for Education: extremism, domestic violence, female genital mutilation, gangs, drugs and many more. Will the Home Secretary be able to work with the Education Secretary to ensure that there is compulsory personal, social, health and economic education for everybody, including sex and relationships education?

Theresa May: The hon. Gentleman has worked hard to get that issue into a statement about extremism in our schools. The Education Secretary and I talk about those issues, and our Departments work together on them. We are constantly looking to ensure that what we do in our schools provides the right education for our children, and one that helps them to tackle a range of issues that might make them feel pressurised, including the important one—extremism—we are talking about today.

Keith Vaz: The Home Secretary is right to remind the House that she alone has overall responsibility for counter-terrorism in the Cabinet. In the past three years, the Home Affairs Committee has conducted two major inquiries into extremism, but no Minister from any Department has given us written or oral evidence to suggest that there was a problem with Birmingham schools. She was correct in writing to the Education Secretary, and she raised four important, indeed critical questions. Has she received a reply to the questions in the letter she sent last Tuesday, and does she agree that the Prevent strategy is always capable of improvement? We do not need just to prevent; we need to engage with communities to rid ourselves of extremism.

Theresa May: The right hon. Gentleman is right, in that, of course, there is a spectrum of activity that we need to be involved in. At one end, some of that is about actively working to prevent people who want to undertake or plan terrorist acts against us from doing so. But at the other end there is obviously the wider integration work with communities, and in many cases helping to support communities to address issues of extremism and radicalisation, should they see them in their streets and local institutions. On the first point, the right hon. Gentleman knows full well that my right hon. Friend the Education Secretary will make a statement at the
	end of this urgent question on what has been happening in schools in Birmingham, and I suggest he waits for that.

Crispin Blunt: In danger of being lost among the regrettable froth over this issue is that for four years, my right hon. Friend has presided over a team of officials who deal with these issues and who have worked extremely well in developing a globally leading policy, and in adjusting in a dynamic policy environment. We as a nation should be grateful for how well we are served, and for the leadership the Home Secretary has given.

Theresa May: I thank my hon. Friend, and he is right to point out that the strategies we have adopted are looked to with respect around the world. Of course there is always more for us to do, which is why we look constantly at the work we are undertaking to ensure that we are doing as much as possible and learning any lessons from the past. We have a good record on the strategies we have put in place. Yes, we can look to do more, as I have said, but we should not lose sight of the fact that Contest and Prevent are looked at with respect around the world.

Seema Malhotra: I spoke last week to Muslim leaders in my constituency, and I recognise that the vast majority of the Muslim community are extremely concerned about the activity of extremists, not least because they know that their sons and daughters are some of those most at risk. They want to know that they are being backed to keep their families and communities safe. Will the Home Secretary therefore explain why she cut the anti-extremism programmes’ support for community action from £17 million for 93 local authorities to £1 million for 30 local authorities?

Theresa May: First, it is indeed important to reach out to and work with communities, as I have said in response to a number of questions this afternoon. I am sorry to repeat the point I made to the shadow Home Secretary, but we have changed the way that various parts of what was the last Government’s Prevent strategy are delivered. We therefore cannot look at Home Office figures and say that there has been a cut in funding, because the Home Office has changed, and we are funding activity that is much more focused than it was. Two Departments are responsible for the different elements of the Prevent strategy, and the reason for that is simple: it is precisely Muslim communities who were getting concerned about the way the strategy operated under the last Government, and its mixing of the counter-terrorism strategy with communities integration work. We responded to that.

Nicola Blackwood: Does the Home Secretary agree that combating extremism and building trust in communities will work only if there is action in communities consistent with the rhetoric in this place? Denouncing organisations from the Dispatch Box is not good enough; we also have to end funding to extremist organisations in communities.

Theresa May: My hon. Friend is right and that is why, as part of the revised Prevent strategy, we put in place explicit procedures to try to ensure that funding does
	not go to organisations that have extremists within them or that do not respect the values we all hold dear. This Government put that new strand into the Prevent strategy because we saw the importance of not funding extremism.

Dennis Skinner: If the Home Secretary’s case is so convincing, why did she not manage to convince the Secretary of State for Education? Is it because there is an alternative agenda in the Tory party, which is that, post-election, the nasty party is getting ready for a succession battle and the Home Secretary is battling with the Secretary of State for Education? That is what is really happening—that is the truth. She might not like it, but that is what the people out there think.

Theresa May: I do not think that question should be dignified with a response.

Tony Baldry: May I remind my right hon. Friend that, after the general election, practically the first meeting the Secretary of State for Communities and Local Government attended was at Lambeth palace, where all the nation’s faith leaders were present? He committed the Government to fund and support the Near Neighbours programme, which enables faith communities throughout the country to work together to promote integration and tackle extremism. If this “duff up the Home Secretary” urgent question has achieved nothing else this afternoon, it will at least, hopefully, better explain to the Opposition and others where the division of responsibilities lie in government for counter-terrorism on the one hand and community integration on the other.

Theresa May: My right hon. Friend is absolutely right. He is right to draw attention to the excellent work the Department for Communities and Local Government has been doing under the leadership of my right hon. Friend, the Secretary of State. Indeed, my right hon. Friend, the noble Baroness Warsi has been doing very important work to bring communities together, particularly faith communities, to share their experiences and increase understanding between them. That is a vital part of the integration work that I would have hoped we all, across the Chamber, accept is necessary. We should support it wherever we see it.

Pat McFadden: While we are on the subject of extremism, will the Home Secretary update the House on the whereabouts of the two control order suspects who escaped following her decision, and the Prime Minister’s decision, to remove the relocation power in the previous regime, which had prevented abscondences for many years? Does she know where those suspects are, and do they still pose a threat to the public?

Theresa May: I have answered this question on a number of occasions. Law enforcement agencies continue to pursue this matter, as they have done since the absconds.

David Nuttall: Does the Home Secretary agree that one of the best ways to prevent the development of extremist views is through
	the work of interfaith groups, such as the Bury Muslim Christian Forum in my constituency, which provides a platform to explain the implementation of the Prevent strategy?

Theresa May: My hon. Friend is absolutely right. He is right to promote and recognise in this House the good work being done by the Bury Muslim Christian Forum in his constituency. It is exactly that sort of work at community level—people coming together to increase their understanding of each other—that is so valuable in the work of integration of our communities.

David Lammy: In December 2009, when I was Minister with responsibility for higher education, a young man, Abdulmutallab, boarded a plane between Amsterdam and Detroit intent on bombing that plane. There were, as the Home Secretary would imagine, intense conversations between the Department with responsibility for universities and the then Home Secretary. Those conversations never made their way into the public domain. Given the seriousness of what has happened, and with the attack in Pakistan just yesterday, should the Home Secretary not come to this House and apologise, like the Secretary of State for Education, for what has happened in the past few days?

Theresa May: First, the right hon. Gentleman does well to remind us of the terrible incident that has taken place in Pakistan. Our thoughts should go out to all those who have been victims of that terrible attack. Pakistan has suffered more loss of life through terrorist acts than anywhere else. That is a fact I have recognised on a number of my visits to Pakistan and it is a fact we should recognise in this House. As to other matters, the question of those who go and preach, and attend and speak at universities is important, and is one that I discuss with the Department for Business, Innovation and Skills. We ensure that Prevent co-ordinators are there to be able to support universities in the necessary work they are doing to help to support those on their campuses.

David Davies: Does my right hon. Friend agree that this issue is far too important to be treated as some sort of political football and that Members of all parties would do better to unite behind the Government in trying to tackle this problem?

Theresa May: My hon. Friend is right in that this issue is one where we would hope that people would work across the House to ensure that we provide the support that communities need to carry out the necessary work referred to by a number of Members today. This is an important issue. My right hon. Friend the Secretary of State for Education will make that clear in the statement he is about to give. This Government take seriously the issues about what has been happening in Birmingham schools, just as they take seriously issues relating to extremism in any form wherever it appears.

Lyn Brown: Given the Home Secretary’s very punchy response about this Government’s commitment to combating radicalism, engaging with communities and supporting and integrating our communities so that they can tackle extremism in their midst, will she confirm, following the question from my
	hon. Friend the Member for Feltham and Heston (Seema Malhotra), that she has only £1 million left from the £17 million budget to do that?

Theresa May: I have to say to the hon. Lady that the Opposition’s assumption that they can somehow look at figures relating to the Prevent strategy, which has been split, and quote them as somehow indicating what this Government are doing wrong is a path down that she should not be going down.

Stephen O'Brien: Following the robust and clear answer from the Home Secretary, the only urgent question for the House to consider today is the misjudgment of the shadow Home Secretary. As part of the Prevent and counter-terrorism strategy for which my right hon. Friend and her Department are responsible, will she reinforce the importance of the work that the National Crime Agency is doing in countries in west and north Africa, which, as I see with my own eyes, is having a significant effect, albeit with quite small resource, to help prevent further terrorism taking place in this country as well as abroad?

Theresa May: My right hon. Friend makes a very important point. In looking at the work done against terrorism, we increasingly see across the world linkages between organised crime and terrorism. It is exactly in this way that the National Crime Agency, with its work on organised crime and how it feeds into terrorism, is so important. The NCA takes this issue very seriously, and I am pleased to say that, since it was set up, it has done some real and important work, as my right hon. Friend says, particularly in a number of countries in north and west Africa, with which he is familiar through the work he has done for the Prime Minister.

Ian Lucas: Who authorised posting the letter to the Education Secretary on the Home Office website?

Theresa May: I have been absolutely clear that I did not authorise the letter going on to the website.

Ian Lucas: Who?

Theresa May: The Cabinet Secretary undertook an investigation for the Prime Minister; that investigation was concluded; and the recommendations went to the Prime Minister.

Ian Lucas: Who?

Theresa May: Hon. Members will be aware—

Ian Lucas: Who?

Mr Speaker: Order. Mr Lucas, I understand your frustration, but I have told you before that your apprenticeship to become a statesman still has some distance to travel. You must not holler from a sedentary position. Allow the Home Secretary to respond, and others will have their opportunity.

Theresa May: Thank you, Mr Speaker.
	As I said, the investigation was concluded; it went to the Prime Minister; he looked at its recommendations; and, as hon. Members will know, my special adviser resigned on Saturday.

George Freeman: I welcome my right hon. Friend’s track record on actions speaking louder than words, as she has excluded more hate preachers than any predecessor and has achieved successfully the legal deportation of Abu Hamza and the review of the Prevent strategy—a strategy that the former Chairman of the Select Committee referred to, as my right hon. Friend may be aware, as lacking
	“clear-sighted and consistent ministerial leadership”—[Official Report, 10 July 2006; Vol. 448, c. 1123.]
	under the last Government.

Theresa May: I thank my hon. Friend for reminding us of that quotation from the Chairman of the Select Committee. It would appear that Opposition Members have forgotten what was said by a Committee of this House about the strategy that applied under the last Government. We have changed that strategy and made it more effective. We in the Home Office are focusing more clearly on the counter-terrorism aspects, and, as we have heard, the communities integration aspects are being dealt with by the Department for Communities and Local Government.

Andrew Gwynne: It appears that the Home Secretary has just blamed her special adviser for the unauthorised publication of her letter to the Education Secretary. Given that she said in her statement that she had acted immediately, why did it take a whole three days for that letter to be removed from the website? Does she not need to get a grip on her Department?

Theresa May: The hon. Gentleman is getting his quotations mixed up. I made it absolutely clear in my statement, and in my response to the hon. Member for Wrexham (Ian Lucas), that the Cabinet Secretary and the Prime Minister concluded that I did not authorise the release of the letter. Following the review, certain things took place in relation to the Education Secretary, and in relation to further comments that were made to The Times, my special adviser Fiona Cunningham resigned on Saturday.

Jesse Norman: Does the Home Secretary share my surprise, indeed astonishment, that it had to fall to her to impose bans on hate preachers and to set up an extremism unit, and that those things were not done under the last Labour Government?

Theresa May: My hon. Friend has attributed to me an action to which I referred earlier and which was actually taken by the Education Secretary, namely the setting up of an extremism unit in the Department for Education. However, as I said earlier, I have banned more hate preachers than any other Home Secretary. That is because this Government take the clear view that we want to deal with not just violent but non-violent extremism, which is clear from the actions that we have taken.

Nia Griffith: The Home Secretary seems to be using the word “immediately” instead of the words “after three days”. No wonder my constituents are panicking about getting their passports on time. Can she explain why she allowed her letter to remain on the website for three days? Did she not know about it? Was it with her authorisation? Has she any sense that three days is far too long in relation to something that was supposed to have been removed immediately?

Theresa May: I have answered that question on a number of occasions. I did make reference to immediate action that was taken. I made reference to that in response to the shadow Home Secretary. The Prime Minister initiated an investigation by the Cabinet Secretary, and that investigation was concluded at the end of last week.

David Ward: I am very concerned about some of the language that has been used today. We are here to listen to statements which, I remind the House, have been prompted by what has been deemed to be the inappropriate behaviour of governors in some schools in Birmingham, yet the Home Secretary’s statement began with a reference to Lee Rigby. Is it right to use the same word, “extremism”, to cover both forms of activity, and, if so, are we going to replace the term “devout Catholics” with “extremist Catholics”, or change the term “committed Christians” to “extremist Christians”? How can we have a sense of proportion if we are using the same word to cover such a vast range of behaviour?

Theresa May: I think that when my hon. Friend looks at the record of what he has said in Hansard, he may regret the tone and approach that he has taken. I did make reference to the murder of drummer Lee Rigby. That murder was a terrorist attack. It took place just over a year ago in this country. It was one of two terrorist attacks that took place in this country last year. I referred to it because I wanted to refer to the extremism taskforce, which the Prime Minister set up following that murder. The taskforce reported at the end of last year, and the Government are acting on its recommendations.

Mike Gapes: The Home Secretary has said on more than one occasion that the last Labour Government were somehow funding extremist organisations, yet she, as Home Secretary, cut funding for the Quilliam Foundation. Is she implying that the foundation is a pro-extremist organisation?

Theresa May: No, of course I was not implying that. I have to say to the hon. Gentleman that he could do better than that.

Paul Uppal: I spent many of my early years being educated in south Birmingham. May I say to my right hon. Friend and to other hon. Members that the pressures on young people from the south Asian diaspora are intense and powerful and can come from community leaders, religious leaders and even from the extended family? The crucial issue is that, if we are to make progress, we must move away from the focus on counter-terrorism towards integration, where young people can have their own identity, but within the context of British values.

Theresa May: My hon. Friend has spoken very wise words and he is absolutely right.

Kevin Brennan: The Home Secretary’s special adviser had to resign–it was right that she did so—although, after what the right hon. Lady said, we do not know whether that is related to the letter. The Education Secretary, rightly, was disciplined for breaching the ministerial code. Does the Home Secretary feel that she bears any responsibility for “certain things” that have happened?

Theresa May: The hon. Gentleman is well aware of the progress of what happened in relation to the Cabinet Secretary’s investigation of last week’s events. The investigation took place at the request of the Prime Minister. The Cabinet Secretary did that swiftly and a number of actions resulted from it.

Andrew Selous: In terms of effective cross-Government working, the Home Secretary has told us that she has reformed the Prevent strategy. She has told us that the Education Secretary has set up a dedicated extremism unit and that excellent community cohesion work is being led by the Communities Secretary. Will she assure the House that that cross-Government work will continue effectively?

Theresa May: My hon. Friend is right. That work will continue. Indeed, other Departments are working with the Home Office under the aegis of the Prevent strategy: for example, the Department for Business, Innovation and Skills. That Department has responsibility for universities, and I referred earlier to the issue of speakers at universities. The Ministry of Justice is also working with the Home Office under that strategy in relation to what happens in prisons and the work of the National Offender Management Service. Other Departments are involved in the strategy with the Home Office. This is genuinely a cross-Government approach to deal with extremism in all its forms.

Stephen McCabe: Is the Home Secretary happy that her new strategy is working absolutely as she intends, or has she any lessons to learn from the mistakes, apologies and resignation of the past week?

Theresa May: On the Prevent strategy and the work that the Government do on extremism, as I said earlier, there is always more work that the Government can do. It is imperative that we look constantly at what we are doing to ensure that it is delivering the results that we need. However, as I have already said, it was last year, following the appalling murder of Drummer Lee Rigby, that the Prime Minister set up an extremism taskforce to bring all Departments involved across Government together and to look at whether more could be done. A number of recommendations came out from that and we have been working on them.

Andrew Bridgen: Does my right hon. Friend agree that the last Government completely failed to promote the integration of religious and ethnic minority groups into mainstream British
	society? It is within these insular and isolated communities that radicalisation and extremism can take root and prosper.

Theresa May: It is imperative that we work to ensure the full integration across our society of people living in this country and that we do not attempt to excuse separatism in some way. Often, that was what was done by the last Government.

Rushanara Ali: The public row between the Home Secretary and the Education Secretary is deeply disturbing when it is on a matter of national security. What will she do to restore trust among the British public, especially law-abiding British Muslims who feel targeted because of the appalling rhetoric in the media? We need to ensure that people can trust the Government to work in their interest to build cohesion and prevent extremism.

Theresa May: The concern about the impact that Government work has on the British Muslim community was precisely why we decided when we came into government to separate the integration strand of Prevent from the counter-terrorism strand. We felt that there was a concern about Prevent’s operation precisely because of its counter-terrorism element. Therefore, the integration elements were not looked at as positively as they should have been.
	What do we need to do as a Government from this point? My right hon. Friend the Education Secretary will indicate what action he will be taking in connection with schools in Birmingham and related matters. All of us need to operate collectively at the grassroots level to make sure that we are reaching out to British Muslim communities and others and are undertaking the work that some of my hon. Friends have mentioned in Bury and elsewhere to bring faith communities in particular together.

Rehman Chishti: As somebody from a Muslim background whose father was an imam, may I ask the Secretary of State whether she agrees that one of the major failings of the previous Government was that they failed fully to integrate communities? The previous Government looked at integration through the narrow prism of counter-terrorism, which led to a major breakdown with the Muslim communities around the country, and we must address that. Linked to that, does she agree that we have to address the issue of extremism and radicalisation on the internet, which poses a grave threat to our country?

Theresa May: On the first point, my hon. Friend is absolutely right and that is precisely why we took the decision to separate the strands of the Prevent work. On the second point, he is also right in that we need to work on addressing the material on the internet. The police’s Counter Terrorism Internet Referral Unit has been set up—to be fair, it was set up at the beginning of 2010, so before this Government came into office, but we have accelerated its work, and in recent months, following the extremism taskforce which identified this as a particular issue, an increased number of items have been taken down from websites because of terrorism content.

Pat Glass: Birmingham city’s council and national strategies were raising concerns about these issues in Birmingham schools with the Department for Education in writing in 2010. When did the Secretary of State become aware of these concerns in relation to Birmingham schools?

Theresa May: The issue of concerns in Birmingham schools and how that has been addressed by the Department for Education is, of course, a matter that my right hon. Friend the Education Secretary will be raising.

Peter Bone: In Wellingborough we have strong Muslim, Hindu and Sikh communities, but they are integrated. Does the Home Secretary agree that we must not give the impression today in this House that there is extremism across the country?

Theresa May: My hon. Friend is absolutely right. That is one of the reasons why when the Home Office looked at Prevent funding and dealing with Prevent and its counter-terrorism strand, we said that we should be focusing the money not according to the number of Muslims living in a community but according to the risk of radicalisation, because that was the issue we were addressing. I am sorry to say it has been reported that the shadow Home Secretary suggests that was a false move, which implies that she thinks money should be spent just on the basis of how many Muslims are living in a particular community. I do not agree with that. I think it gives the wrong message about people in our Muslim communities. We should be focusing on where we believe there is genuine radicalisation.

Stephen Doughty: The Home Secretary will be aware of the recent case of Aminu Sadiq Ogwuche, a former university student in Wales who was recently held in Sudan in connection with a bombing of a bus station in Abuja by Boko Haram, which killed over 70 people. Given the serious concerns rightly raised about the co-ordination of Government policy in this instance, will the Home Secretary assure the House that there is co-ordination of policy in relation to universities, and not just schools?

Theresa May: Yes, we take very seriously what might be happening on university campuses. My right hon. Friend the Minister for Universities and Science has spent a lot of time looking at this issue, and we are constantly working with universities to ensure that action can be taken on their campuses to try to stop the sort of radicalisation and the extremist preachers that have been on some campuses in the past.

Mel Stride: Will my right hon. Friend confirm that, along with central Government funding, local authority funding will be promptly removed from organisations engaged in the promotion of hatred and violence?

Theresa May: The policy that we have put in place makes it clear that public funding, whatever its source, should not be spent on organisations with extremist intent.

Huw Irranca-Davies: The Home Secretary has today repeatedly denied that she authorised the placement of the letter on the Home Office website, but equally, she has repeatedly refused to say who did authorise its placement. Do special advisers in the Home
	Office have free access to the Home Office website, so that they can post things on it, and to the general communications strategy of the Home Office?

Theresa May: I have addressed the issue underlying the hon. Gentleman’s question on a number of occasions.

Michael Ellis: The Labour party is focusing on whether the Home Secretary should personally micro-manage websites, but is not the real issue the fact that under this Government the Prevent strategy, which confuses the Labour party, has been properly split between communities and counter-terrorism? That is the way that it should be. It is one of the many areas where Labour got it wrong but we are getting it right.

Theresa May: My hon. Friend is absolutely right. At the core is the question of how we deal with extremism, which is what the Prevent strategy is about. We took the right decision on that strategy, and it is a pity that the Opposition do not seem to understand the implications of that.

Alex Cunningham: Will the Home Secretary now increase spending on anti-extremism programmes?

Theresa May: I apologise—I did not quite catch the beginning of the hon. Gentleman’s question. We look closely across the board at how the Home Office budget is spent. We also look closely at the Prevent funding, and we have introduced measures, which were not there under the last Government, to ensure that we can ascertain not only how much is being spent on a particular project but the effectiveness of the spend. The last Government did not seek to find out whether they were spending public money effectively.

Charlie Elphicke: Does the Home Secretary share my concern that there have been too many occasions when the battle against extremism has been hampered by European human rights? Does she agree that human rights reform will enable us not only to take the battle to extremists but to promote integration and make our communities safer and more secure?

Theresa May: My hon. Friend returns to a topic on which he has questioned me in the past, and on which I have made a number of statements in the House. In the cases of the extradition of Abu Hamza and the deportation of Abu Qatada, there were certainly delays due to the operation of the European Court of Human Rights. I have also made it clear in the House that the Conservative party is committed to going into the election with policies relating to the reform of the Human Rights Act 1998 and of our relationship with the European Court.

Wayne David: Did the Home Secretary authorise the release to the media of the letter to the Education Secretary?

Theresa May: I think I have answered that question already. I did not authorise the release of the letter, and the Cabinet Secretary and the Prime Minister have concluded that the ministerial code was not broken.

Nigel Evans: Does the Home Secretary agree that the vast majority of Muslims in the United Kingdom despise hate crimes, extremism and terrorism, and that we in this House all have a duty to do what we can to promote inclusion within our own communities?

Theresa May: My hon. Friend is absolutely right to say that everyone in the House has a duty to promote inclusion. He is also right that the majority of people in Muslim communities despise hate crimes. Sadly, too many people in Muslim communities are themselves the victims of hate crimes; we should not forget that.

Jenny Chapman: The Home Secretary has made it clear that she herself did not authorise the publication of the letter, but she has implied that her former special adviser might have done so. Her former special adviser has lost her job, but has she apologised to the Home Secretary for the error?

Theresa May: I suggest that the hon. Lady look closely at what I have already said, when it is reported in Hansard. I have been very clear about what happened as a result of the investigation by the Cabinet Secretary, which the Prime Minister required to be undertaken.

Aidan Burley: Integration is not just about preventing young people from engaging in extremism; it is also about reintegrating them into their communities when they have been radicalised. What steps is my right hon. Friend’s Department taking to reintegrate people who have strayed in that way?

Theresa May: Within the Prevent strategy is the important Channel strand which works with people who are perhaps at risk of being radicalised—who are particularly vulnerable—to help ensure that they do not move down that path of radicalisation. Of course we also work with the National Offender Management Service on dealing with people who have been prosecuted and imprisoned under the terrorism legislation when they return to their communities.

Nicholas Dakin: Did the Home Secretary know that her special adviser was going to release the letter in the way that she did?

Theresa May: I have answered quite a few questions in responding to this. [Interruption.] Opposition Members can ask the question as many times as they like, but they will get the same answer. I also have to say that it is a bit rich getting so many questions about special advisers from the party of Damian McBride.

Andrew Stephenson: Does the Home Secretary agree that her reforms to split Prevent funding between Departments were essential, as the only result of the previous Government’s attempts to promote integration through the prism of counter-terrorism was to stigmatise law-abiding Muslim communities in constituencies such as mine and give succour to the British National party?

Theresa May: My hon. Friend is absolutely right: the problem with the way the previous Government dealt with the Prevent strategy was that the integration part—the
	inclusion and communities work—became, in the eyes of many people in Muslim communities, tainted by its relationship with counter-terrorism. That is why it was absolutely right to split those two parts of the strategy and have them addressed under two Departments—the Home Office on counter-terrorism and the Department for Communities and Local Government on communities and inclusion.

Toby Perkins: The reason people keep asking the Home Secretary questions along the same lines is that she is refusing to answer them: she refuses to say who authorised the publication of that letter, and she refuses to say when she first found out about extremism in Birmingham schools. Will she at least tell us when she found out that the letter had been published and what action she took at that time?

Theresa May: The action taken was that the Cabinet Secretary was asked to investigate all the circumstances around this. He did that, he reported to the Prime Minister, and a number of actions resulted from that recommendation to the Prime Minister.

Therese Coffey: My constituents will have been reminded today of the serious errors made under the previous Government in funding extremist groups. My right hon. Friend is right to stress the importance of inclusion, but will she join me in paying tribute to the officials in the Home Office and the intelligence services who work day in, day out to keep people in this country safe?

Theresa May: I thank my hon. Friend for reminding us of the very important work done day in, day out, not just by officials in the Home Office but by individuals in our security services and law enforcement bodies to keep us safe. They have to work at that minute by minute, hour by hour, day by day doing the valuable work that they do. We should record our thanks to them once again—it is their work that helps to keep the public safe.

Jonathan Ashworth: I am going to press the Home Secretary again on the nature of the unauthorised correspondence. It was on the website for three days. She said that the Cabinet Secretary launched an investigation. Did she therefore make the judgment at the start of that investigation not to take down the correspondence from the website? Did she wait for the Cabinet Secretary to tell her to take it down?

Theresa May: The Prime Minister initiated the investigation by the Cabinet Secretary. He looked into those matters. They were considered fully and properly, and recommendations resulted.

Nadhim Zahawi: Rather than obsessing over process, the Home Secretary is right to talk about learning the lessons of the past. In trying to reach out to the groups most at risk of radicalisation, did funding from the previous Government sometimes reach groups that were extremist in their views and organisations that should not be funded in that way? What is she doing to prevent that situation from recurring?

Theresa May: My hon. Friend is right that what we saw, sadly, was that it was possible for funding to reach organisations that had extremists within them, that had some form of extremist intent or that had links to extremism. We have put in place a proper process within the funding arrangements that means that we look at organisations and require them to be clear about how they share British values in the way that they operate to ensure that Government are not funding extremism.

Geraint Davies: Does the Secretary of State accept that open warfare between her and the Education Secretary is completely undermining public confidence in this Government to engage with communities and to be tough on terrorism and the causes of terrorism? We need to get rid of the turf war shambles and replace this Government with a new Labour Government.

Theresa May: What undermines—[Interruption.]

Mr Speaker: Order. The Home Secretary’s response must and will be heard.

Theresa May: What potentially undermines the confidence of the public in attempts to deal with extremism is seeing the Opposition playing party politics with the issue rather than dealing with it seriously.

Paul Maynard: Given the advocacy by the shadow Home Secretary of an alternative, broader Prevent strategy, does the Home Secretary share my concern that we could go back to a time when public funds are used to support groups and individuals who support segregation, not integration, which does nothing to diminish the extremism that everyone, on all sides of the House, wants to see expunged from this country?

Theresa May: My hon. Friend has made an extremely serious point. It is important for us all to work towards inclusion, integration and full participation in society and in no way to attempt to enforce a separation of groups. Indeed, the danger of the previous Government’s Prevent strategy was that it was not able to work effectively on inclusion precisely because of the way they had set it up.

Michael Fabricant: A couple of years ago, I visited a Buddhist centre in my constituency, and the Abbott told me how, before the last general election, the members of the centre were driven out of their Birmingham base by radical Muslim extremists. Does my right hon. Friend agree that, sadly, there are elements of the Muslim community who are extreme? These extremists put fire bombs and excrement through the letterbox of the Buddhist centre. Is it not right that this Government should target their efforts to ensure that that sort of extremism is stamped out?

Theresa May: I deplore the actions that my hon. Friend has described today. Nobody should be driven out of their home or their centre by such actions. It is absolutely right that we address extremism; we need to address it in all its forms. We have changed Prevent so that it deals not just with violent extremism but with non-violent extremism and extremism in all forms. I mentioned
	earlier that there were two terrorist attacks in the United Kingdom last year. I have referred to one of them, which was the murder of Drummer Lee Rigby. We also saw a far right extremist murder Mohammed Saleem. We must never forget that extremism can take many forms.

Birmingham Schools

Michael Gove: With permission, Mr Speaker, I should like to make a statement on schools in Birmingham.
	Keeping our children safe and ensuring that our schools prepare them for life in modern Britain could not be more important; it is my Department’s central mission. Allegations made in what has become known as the Trojan horse letter suggested that children were not being kept safe in Birmingham schools. Ofsted and the Education Funding Agency have investigated those allegations. Their reports and other relevant documents have today been placed in the Library. Let me set out their findings and my actions.
	Ofsted states that
	“headteachers reported...an organised campaign to target…schools...in order to alter their character and ethos,”
	with
	“a culture of fear and intimidation.”
	Head teachers who had
	“a record of raising standards”
	reported that they had been
	“marginalised or forced out of their jobs.”
	One school leader was so frightened about speaking to the authorities that a meeting had to be arranged in a supermarket car park.
	Ofsted concluded that governors
	“are trying to impose and promote a narrow faith-based ideology in what are non-faith schools”
	specifically by narrowing the curriculum, manipulating staff appointments and using school funds inappropriately.
	Overall, Ofsted inspected 21 schools. Three were good or outstanding; 12 were found to require improvement. The remaining six are inadequate, and are in special measures. Let me explain why. At one secular primary school, terms such as “white prostitute”, unsuitable for primary children’s ears, were used in Friday assemblies run exclusively by Muslim staff. The school organised visits to Saudi Arabia, open only to Muslim pupils, and senior leaders told inspectors that a madrassah had been established and paid for from the school’s budget. Ofsted concluded that the school was
	“not adequately ensuring that pupils have opportunities to learn about faith in a way that promotes tolerance and harmony between different cultures”.
	At one secular secondary school, staff told officials that the call to prayer was broadcast across the playground on loud speakers. Officials observed that lessons had been narrowed to comply with conservative Islamic teachings. In biology, students were told that
	“evolution is not what we believe”.
	The school invited the preacher Sheikh Shady al-Suleiman to speak, despite the fact that he is reported to have said: “Give victory to Muslims in Afghanistan... Give victory to all the mujaheddin all over the world. Oh Allah, prepare us for the jihad.” Ofsted concluded that
	“governors have failed to ensure that safeguarding requirements and other statutory duties are met”.
	At another secular secondary school, inspectors described “a state of crisis”, with governors reportedly using school funds to pay private investigators to read the e-mails of senior leaders, and Ofsted found that there
	was a lack of action to protect students from extremism. At a third secular secondary school, Ofsted found that students were
	“vulnerable to the risk of marginalisation from wider British society and the associated risks which…include radicalisation”.
	At a secular primary, Ofsted found that
	“pupils have limited knowledge of religious beliefs other than Islam”
	and
	“subjects such as art and music have been removed—at the insistence of the governing body”.
	Inspectors concluded that the school
	“does not adequately prepare students for life in modern Britain”.
	Ofsted also reported failures on the part of Birmingham city council. It found that the council did not deal adequately with repeated complaints from head teachers. School leaders expressed “very little confidence” in the local authority, and Ofsted concluded that Birmingham had not exercised adequate judgement. These findings demand a robust but considered response. It is important that no one allows concern about these findings to become a pretext for criticism of Islam itself—a great faith that brings spiritual nourishment to millions and daily inspires countless acts of generosity. The overwhelming majority of British Muslim parents want their children to grow up in schools that open doors rather than close minds. It is on their behalf that we have to act.
	There are critical questions about whether warning signs were missed. There are questions for Birmingham council, Ofsted and the Department for Education. Today, I have asked Birmingham council to review its history on this issue, and the chief inspector has advised me that he will consider the lessons learned for Ofsted. I am also concerned that the DFE may not have acted when it should have done. I am asking the permanent secretary to investigate how my Department dealt with warnings since the formation of this Government in 2010, and before. We must all acknowledge that there has been a failure in the past to do everything possible to tackle non-violent extremism.
	Let me make it clear that no Government and no Home Secretary have done more to tackle extremism than this Government and this Home Secretary. In the Prime Minister’s Munich speech of 2011, in the Home Secretary’s own review of the Prevent strategy, and in the conclusions of the Government’s extremism taskforce last year, this Government have made it clear that we need to deal with the dangers posed by extremism well before it becomes violent. Since 2010, the DFE has increased its capacity to deal with extremism. We set up Whitehall’s first ever unit to counter extremism in public services, with help from former intelligence and security professionals. That unit has developed since 2010, and we will continue to strengthen it.
	Ofsted now trains inspectors to understand and counter extremist Islamist ideology, and inspections of schools at risk, like those in Birmingham, are carried out by the most senior inspectors, overseen by Michael Wilshaw himself.
	There is, of course, more to do, and today’s reports make action urgent. First, we need to take action in the schools found to be inadequate. Academies will receive letters saying that I am minded to terminate funding agreements; in local authority schools, governors are being replaced. We have already spoken to successful academy providers who are ready to act as sponsors.
	We need to strengthen our inspection regime even further. The requirement to give notice of inspections clearly makes it more difficult to identify and detect the danger signs. Sir Michael Wilshaw and I have argued in the past that no-notice inspections can help identify when pupils are at risk. I have asked him to consider the practicalities of moving to a situation where all schools know that they may receive an unannounced inspection. I will also work with Sir Michael Wilshaw to ensure, as he recommends, that we can provide greater public assurance that all schools in a locality discharge their full statutory responsibilities, and we will consider how Ofsted can better enforce the existing requirement that all schools teach a broad and balanced curriculum.
	I have talked today to the leader of Birmingham council and requested that it sets out an action plan to tackle extremism and keep children safe. We already require independent schools, academies and free schools to respect British values. Now we will consult on new rules that will strengthen this standard further, requiring all those schools actively to promote British values, and I will ask Ofsted to enforce an equivalent standard on maintained schools through changes to the Ofsted framework.
	Several of the governors whose activities have been investigated by Ofsted have also been active in the Association of Muslim Schools UK, which has statutory responsibilities in relation to state Muslim faith schools. So we have asked AMS UK to satisfy us that it is doing enough to protect children from extremism, and we will take appropriate steps if its guarantees are insufficiently robust.
	I have spoken to the National College for Teaching and Leadership, and we will further strengthen the rules so that from now on it is explicit that a teacher inviting an extremist speaker into a school can be banned from the profession.
	I will, of course, report in July on progress in all the areas that I have announced, as well as publishing the findings of the report of Peter Clarke, who is investigating the background behind many of the broader allegations in the Trojan horse letter. The steps we are taking today are those we consider necessary to protect our children from extremism and to protect our nation’s traditions of tolerance and liberty.
	The conclusions of the reports today are clear. Things that should not have happened in our schools were allowed to happen. Our children were exposed to things that they should not have been exposed to. As Education Secretary, I am taking decisive action to make sure that those children are protected. Schools that are proven to have failed will be taken over, put under new leadership and taken in a fresh new direction. Any school could now be subject to rigorous, on-the-spot inspections with no advance warning and no opportunities to conceal failure. And we will put the promotion of British values at the heart of what every school has to deliver for children. What we have found was unacceptable, and we will put it right. I commend this statement to the House.

Tristram Hunt: The events in Birmingham reveal an education policy in disarray, a Government more concerned about warring egos than school standards and a Prime Minister unable
	to control his Cabinet. But while Ministers carry on their briefings, sackings and apology, the education and safeguarding of children in the great city Birmingham must be this House’s priority.
	I appreciate the anxiety which parents and pupils are feeling in the midst of this debate. Our focus now has to be on ensuring successful futures for the schools identified today, because what the recent weeks has shown is that the Education Secretary’s vision of controlling every school from behind a desk in Whitehall does not work; that Ofsted has to think much more carefully about the nature of its inspection system; that Birmingham city council has, as Sir Albert Bore acknowledged, some tough questions to ask of the quality of leadership in its children and young people’s directorate; that current systems of schools governance are open to abuse; and that there is a broader debate to be had about education and faith, underperformance among minority ethnic groups and the limits of communalism in multicultural Britain. In an age of multiple religions, identities and cultures, we need to be clearer about what a state education means for children of all faiths and no faiths.
	Having read the Ofsted reports, Sir Michael Wilshaw’s letter and the report of the Education Funding Agency, for advance notice of which I thank the Education Secretary, I share the Education Secretary’s concerns about the provision of education and the safeguarding of children in certain schools in Birmingham. It cannot be right that children have been at risk of marginalisation from mainstream society, cultural isolation or even radicalisation. Similarly, the focus on narrow attainment at the expense of students’ personal and social development is a cause for concern. Some of the other Ofsted reports highlight invitations to inappropriate speakers, the downgrading or elimination of sex and relationship education, gender segregation, staff intimidation and a failure to prepare pupils to live in a multicultural society.
	Sir Michael reports governors
	“trying to impose and promote a narrow faith-based ideology in what are non-faith schools.”
	He says:
	“They do not ensure that a broad and balanced curriculum equips pupils to live and work in a multi-cultural, multi-faith and democratic Britain.”
	This is an issue for faith schools as well as non-faith schools. We cannot have such situations in any English schools, and the report by the Education Funding Agency on the culture, ethos and governments of Oldknow academy has raised similar concerns about a restricted curriculum and the furtherance of conservative Islamist views.
	We now have at least four investigations into what is occurring in Birmingham schools and today the Education Secretary has announced yet another, but this is an attempt to evade his own responsibility as Secretary of State. It seems to be everyone else’s problem—the Home Secretary’s, Charles Farr’s, the city council’s—but not his own. The truth is that if he had been in charge of the management of his Department, these issues would not have arisen in recent years. The Secretary of State has said that he has acted with speed on the issue, but the truth is that Ministers have been ignoring it for four years. In 2010, the respected Birmingham head teacher
	Tim Boyes made a presentation to the Department for Education highlighting the risk of a radical agenda infiltrating Birmingham schools, but nothing was done.
	Will the Secretary of State confirm today which Ministers were present at Mr Boyes’s presentation, when he was first informed of the details of Mr Boyes’s presentation, when Ofsted was informed of the details of Mr Boyes’s presentation and when the Government’s extremism task force met to discuss Mr Boyes’s presentation? Or, as the Home Secretary has put it, is it true that the Department for Education was warned in 2010 and, if so, why did nobody act?
	We do not need another massive review by the permanent secretary. Mr Boyes has provided the Department with information on his 2010 meeting and we need to know what steps the Ministers took and why the Secretary of State did not act. We need those answers here today, because the Labour party’s answer is absolutely clear. We need a local director of standards and accountability.
	We know that Park View Educational Trust, the academy chain essential to the controversy, had a free school application turned down in 2013 on security grounds, yet the Secretary of State allowed the trust to take over Golden Hillock the same year. Can he explain why the trust was unfit to set up a free school but was still allowed to take over the Golden Hillock school, despite those security concerns? Who made that decision and what due diligence was undertaken?
	The truth is that events in Birmingham point to a strategic failing in the Government’s education policy. The Secretary of State’s agenda has been an ideology of atomisation and fragmentation: teachers without qualifications; every school an island; a free market of provision; and an attempt to oversee it all from behind a desk in Whitehall. Birmingham has shown that that model is bust. Sir Michael Wilshaw speaks of successful schools in Birmingham having
	“too few opportunities to share their successful practice with others.”
	That is because of Government policy, and Sir Michael recommends a review of the education funding arrangements for auditing governance in academies and free schools, but the Education Secretary’s mantra of centralism and secrecy remains. He has learned nothing from this event. He says that he will personally look at funding agreements, once again from behind a desk in Whitehall, when what we need are local systems of oversight and accountability, with a system of local checks and balances.
	The dramatic change in Ofsted rankings from outstanding to inadequate has also brought into sharp focus the need for inspection criteria that look beyond the exam factory model of recent years. We need young people to excel in their academic and vocational attainment, but to come out of school career-ready, college-ready and life-ready. That is why the Opposition welcomes Sir Michael Wilshaw’s request to have a broad and balanced curriculum added as a further criterion to the inspection framework. We think that it should go further, to look at the development of character, resilience and grit in our school system. The Labour party believes that sex and relationship education should be a part of that.
	The events in Birmingham have brought to light a desperate weakness in Government thinking. On the one hand, there is an education policy designed to fragment and divide, isolate without oversight and increase the risks of radicalisation—

Mr Speaker: Order. I think that the shadow Secretary of State is bringing his remarks to a close in this sentence.

Tristram Hunt: The Education Secretary speaks of requiring all schools to promote British values; all well and good. Among the greatest of British values is an education system that welcomes and integrates migrant communities, builds successful citizens in a multicultural society and secures safety and high standards for all, and the Education Secretary is failing to do so.

Michael Gove: I thank the hon. Member for Stoke-on-Trent Central (Tristram Hunt) for his comments and I agree that we need to focus on successful futures for these schools. I also agree that we need a broader debate, to ensure that all schools—faith and non-faith—make sure that children are integrated into modern Britain. But I regret the fact that in his comments he was not able to let us know the Labour party’s position on no-notice inspections. I am grateful to the hon. Member for Birmingham, Perry Barr (Mr Mahmood) for stressing that he believes that no-notice inspections are right; I am also grateful to the right hon. Member for Dulwich and West Norwood (Dame Tessa Jowell) for stressing that. But I am still none the wiser about the position of the hon. Member for Stoke-on-Trent Central. I am afraid that I am also none the wiser about his position on whether or not it is right to promote British values in schools and right to take the other steps that we have taken.
	The hon. Gentleman asks about meetings between the Department for Education and the Birmingham headmaster, Tim Boyes, in 2010. I can confirm that I was not at that meeting, nor was I informed about its content. That is why I have asked the permanent secretary to investigate, and I have also asked him to look at other occasions before 2010 when warnings were reportedly given. The hon. Gentleman has previously alleged that I was warned by Mr Boyes in 2010 and did not act; that is not the case and I hope that he will make it clear in the future, and withdraw that allegation.
	The hon. Gentleman asks about local oversight of all these schools. It is important to stress that when Tim Boyes raised these issues in 2010 all these schools were facing local oversight from Birmingham city council, and as Sir Michael Wilshaw has concluded, Birmingham city council failed. As Ofsted makes clear, repeated warnings to those charged with local oversight were ignored. Indeed, it was only after my Department was informed about the allegations in the Trojan horse letter that action was taken, and I thank Birmingham city council for its co-operation since then.
	The hon. Gentleman asks what action was taken overall since 2010. It would be quite wrong to allege, as he does, that the Department has taken no action on extremism since 2010; the opposite is the case. As the Home Secretary pointed out, we were the first Department outside her own to set up a counter-extremism unit. Unreported and under-appreciated, it has prevented a number of extremist or unsuitable organisations from securing access to public funds.
	The hon. Gentleman asks about academies and free schools, and the autonomy that they enjoy. First, I must correct him: none of the schools that Ofsted inspected are free schools and all the evidence so far is that free
	schools in Birmingham are proving a success. I must also correct him on the matter of oversight of academies. Academies are subject to sharper and more rigorous accountability than local authority schools. They are inspected not just by Ofsted but by the Education Funding Agency.
	The hon. Gentleman also asks about curriculum inspection. Let me stress that it is already a requirement that schools have a broad and balanced curriculum; the question is enforcement. That means giving Ofsted the tools it needs, such as no-notice inspections and suitably qualified inspectors.
	The problems identified today are serious and long-standing. They require us all to take action against all forms of extremism. I have been encouraged throughout my career by support from Opposition Members—the right hon. Member for Leicester East (Keith Vaz), the hon. Member for Dudley North (Ian Austin), the right hon. Member for Salford and Eccles (Hazel Blears) and the hon. Member for Birmingham, Perry Barr, among others—for a non-partisan approach to fighting extremism. I hope that, after his comments today, the hon. Member for Stoke-on-Trent Central will reflect on the seriousness of these charges and recognise that this is not an appropriate vehicle on which he should make wider criticisms of the school reforms with which he and his party disagree. I hope that, in the future, we can count on him and others working across party boundaries to keep our children safe.

Edward Leigh: Beneath all this froth of what letters were written, by whom and to whom, is not the essential point this: at last we have a Secretary of State—the first—who is prepared in our state secular schools to take on Muslim sensibilities, or the sensibilities of anybody else, to ensure that all religions and all people are treated with equal respect?

Michael Gove: My hon. Friend makes a very important point. Let me stress again—his question gives me the opportunity to do so—that there are exemplary Muslim faith schools and that the contribution of Britain’s Muslim community is immeasurable, and immeasurably for the good. But one of the things that both the Home Secretary and I have sought to do is ensure that in schools or other civic institutions the dangers of extremism, violent or non-violent, are countered head-on.

Jack Straw: May I pick up on the Secretary of State’s previous point? Does he accept that in my constituency, where 30%-plus of the population are of the Muslim faith, there are plenty of schools—faith schools or secular schools—where 100% of pupils might be Muslim but that so far we have been able to avoid allegations of extremism of this kind? That is true elsewhere across the country. If we are to get the overwhelming majority of followers of the Muslim faith on board, it is crucial that we distinguish between those who are devout, but who embrace British values, and those who are extreme. We need to concentrate on those who are extreme and see them isolated.

Michael Gove: I absolutely agree. I thank the right hon. Gentleman for the work he has done to ensure that state-funded schools can provide children and parents in Blackburn with an Islamic faith education that equips them for the 21st century. Let me emphasise that there is
	a key distinction, which this Government have drawn, between perfectly respectable religious conservatism, whatever the faith, and extremist activity. It is vital that that distinction is maintained.
	[
	Interruption.
	]

Mr Speaker: Order. The hon. Gentleman’s chuntering in the background is of no interest or relevance whatsoever.

Stewart Jackson: Is not a key issue that might give rise to extremism and the rejection of British values a cultural one: namely, the unwillingness or inability among some communities to speak English? Is not it important, therefore, to give appropriate financial support in those areas where we need to tackle potential exclusion, and even ghettoisation, to support the teaching of English at the earliest stage?

Michael Gove: My hon. Friend is, as ever, absolutely right. A key element of the Prime Minister’s 2011 Munich speech was an insistence that we do everything possible to ensure that everyone who grows up in this country can speak English fluently, and that is one of the principal aims of our education programme.

Liam Byrne: At times over the past month or two, I have thought that this day would never come. These reports have been kept under wraps, hidden in full from parents, while they have been leaked in part left, right and centre. Parents, who should have been the first to know, have been the last to know about the contents of these reports. I am sure that the Secretary of State will want to apologise to the House for the contempt with which parents have been treated in this debate. Secondly, he knows that I have been at the forefront in calling for this Ofsted process. I am glad that Sir Michael Wilshaw has today said that there is no evidence of an organised plot to radicalise our children or introduce extremism into schools, but four out of the six academies—

Mr Speaker: Order. I do not know with what frequency the right hon. Gentleman contributes from the Back Benches—[Interruption.] Order. I recognise that these matters are of extreme salience to his constituents; I do not need him to tell me that. The simple fact is that his question, which is not yet a question, is far too long—[Interruption.] Order. We must leave it there for now.

Michael Gove: I am grateful to the right hon. Gentleman for the points he makes. It was vital that we ensured that the schools concerned had an opportunity to read the Ofsted reports before they were published and to let us know whether, in their view, there was any factual inaccuracy. It was vital—indeed, he made this point to me in a private meeting—that we did everything possible to ensure that these reports were bullet-proof against challenge. I absolutely share his desire to ensure that we do everything possible to reassure parents. The parents who have spoken out and have contacted Ofsted and the Department for Education want action to be taken, because, as is clear from the reports, the behaviour of certain governors, as reported, is unacceptable.

Alistair Burt: My right hon. Friend’s statement is extremely important. His ability to find the right line in reassuring parents
	across the country that this is not happening everywhere and answering the question, “How did we get where we are?”, regarding some of these schools will be very important. Bearing in mind the possibility of any links outside the United Kingdom, will he assure me that if any information has come to light in the course of the investigations that might link with any other inquiry that has been held in the United Kingdom, or identifies any links to any organisations abroad that might, through their work, be threatening us, it will be made available to the appropriate authorities?

Michael Gove: I am grateful to my right hon. Friend, whose knowledge of these issues as a former middle east Minister is unparalleled. Peter Clarke will use his expertise to marshal and gather all the information necessary to see whether there is any influence, untoward or otherwise, from outside this country.

Khalid Mahmood: Will the Secretary of State confirm that this inquiry will not tar all the Muslim community in Birmingham, other than a few individuals who took it on themselves to lead with this issue and try to wreck the whole community and its reputation? Will he also confirm that the schools will be put back to normal as soon as possible and that whatever structural changes are due are made quickly so that in September children return to a proper education?

Michael Gove: Absolutely: I can provide assurances on both those points. May I take this opportunity to pay tribute to the hon. Gentleman, who has been outstanding in his efforts to ensure community cohesion in Birmingham? He has been one of the first and clearest voices in this House warning us about the dangers of extremism, and his commitment to his constituents is second to none.

Simon Wright: Does the Secretary of State agree that there is uncertainty among many parents about what their children are entitled to be taught in school? Would it not reassure parents if the Government introduced a minimum curriculum entitlement that all state-funded schools would teach?

Michael Gove: I am grateful to my hon. Friend. Schools are, of course, already required to teach a broad and balanced curriculum. I hope that in the weeks ahead we can have an informed debate about the correct balance between the autonomy that schools and head teachers properly enjoy in order to innovate and to have their professional expertise respected and a guarantee to parents that their children are being taught in a way that conforms with the values that we both share.

Gisela Stuart: British values, which the Secretary of State wants to promote, include the rule of law. I am therefore quite troubled by the part of his statement where he said that governors
	“are trying to impose and promote a narrow faith-based ideology in what are non-faith schools”,
	specifically by narrowing the curriculum, manipulating staff appointments and using school funds inappropriately. Surely that is unacceptable, whether the school is secular or a faith school. It needs to be made clear that these standards must apply to schools universally.

Michael Gove: The hon. Lady is absolutely right. Let me stress that prior to the publication of these reports and of Sir Michael Wilshaw’s covering letter, some questioned whether these investigations were worth while. I pay tribute to her for emphasising how important it is that we deal with the findings. I also pay tribute to the shadow Secretary of State for making it clear that Sir Michael Wilshaw’s integrity is unimpeachable.

John Hemming: I thank the Secretary of State for the opportunity to see the papers in advance, there being two schools affected in my constituency. The National Association of Head Teachers has expressed concern that the system of investigation and inspection is rather inchoate and suggested that a more coherent system of investigation of allegations is needed. I agree—does the Secretary of State?

Michael Gove: It is absolutely right that we review how we investigate the problems that have been identified. As the hon. Member for Birmingham, Edgbaston (Ms Stuart) pointed out, it is clear that Ofsted has uncovered a number of unacceptable practices. It is also clear that the Education Funding Agency has additional powers in relation to academies that have been incredibly useful in this regard as well. I am entirely open to considering how, in future, we can provide parents with guarantees that their children are safe.

Shabana Mahmood: It is clear from the reports published today that the central charge that there has been an organised plot to import extremism that has radicalised children in Birmingham has not been met. What there has been is unacceptably poor and bad governance, which has let children, parents and staff down, and which must be tackled. Those two things are not the same. Does the Secretary of State therefore regret the tone of the debate, which has sent a clear message to Muslim parents in Birmingham and beyond that the education of their children will be viewed through the prism of national security?

Michael Gove: I am grateful to the hon. Lady for giving me the opportunity to make two points. She is absolutely right. When the allegations were raised in the original Trojan horse letter, it was important that they were investigated, and the findings we have today are the findings that Ofsted and the Education Funding Agency are competent to deliver.
	Peter Clarke is also looking into some of the broader allegations. One of the reasons he was chosen is that if people have been unfairly alleged to have taken part in activities of which they are entirely innocent, there can be no more effective figure to exonerate them than Peter Clarke.
	I would also emphasise that Sheik Shady al-Suleiman spoke at one of these schools and his comments are now on the record of the House. I think that anyone listening to those comments would recognise that such a speaker in a school is exposing children to the dangers of extremism.

John Redwood: When will we see the Secretary of State’s statement of British values, which I fully support, as I do his whole approach?

Michael Gove: We will consult on the statement of British values shortly.

Roger Godsiff: Amid the general hysteria that has been whipped up over these anonymous allegations, does the Secretary of State accept that there are many decent, good, hard-working school governors in Birmingham who give up their time freely? One of the schools mentioned, Golden Hillock, is right on the edge of the adjoining constituency to mine and many of my constituents’ children go to it. They cannot understand the picture that has been painted of its governors, including the chairman, Mohammed Shafique, and others whom I know, who have been at the forefront of fighting radicalism and terrorism in local communities.
	The Secretary of State has rightly said that it is important that there is community cohesion. Could he therefore explain why Ofsted removed the requirement in the Ofsted inspection to demonstrate what steps schools were taking to address community cohesion? Did Ofsted do that off its own back, did the Secretary of State give his approval, or did he tell Ofsted to remove the obligation?

Michael Gove: Ofsted clearly has the capacity to detect when schools are not adhering to the responsibility to deliver community cohesion, as the reports published today clearly demonstrate. I will not be drawn into the question of individual governors, but let me take this opportunity to underline the broader point the hon. Gentleman makes that there are many who are committed to state education in Birmingham who are doing a superb job, including governors, teachers and school leaders. I should add that maintained schools, faith schools, academies and free schools in Birmingham are all contributing to the renaissance of state education in that city. That only makes it more important that we deal with those schools that are failing to protect children and failing to prepare them for the 21st century.

Nick Gibb: I know at first hand how seriously my right hon. Friend takes the issue of extremism in our schools. Does he agree that there is a sharp contrast between the speed with which he and his Department took action to tackle failing schools and to investigate extremism and the lacklustre approach of Birmingham city council? Will he therefore investigate what oversight Birmingham had over Saltley science college, a community school where Ofsted has just reported the governors spent tens of thousands of pounds of school funds on private investigators, private solicitors and meals in restaurants, and where, according to Ofsted, governance is inadequate and staff are intimidated?

Michael Gove: My hon. Friend makes a very important point. The Department for Education has been faster to react to concerns expressed about schools and to deal with failure than many local authorities. The case of Saltley, a local authority maintained school, is shocking, but let me stress that Birmingham city council is now fully seized of the importance of dealing with this problem. Let me pay tribute to Sir Albert Bore, whom I met earlier today, who now understands fully the vital importance of working with central Government to
	deal with it. Local government has failed in the past. We need to ensure that central and local government work together to deal with this problem.

David Blunkett: May I first welcome the fact that we seem to be moving inexorably towards a national curriculum that is applied nationally? That is progress.
	In the spirit of the Secretary of State’s last answer, will he ask his right hon. Friend the Home Secretary to delve into the Home Office archives for a research report of 10 years ago—funded by the Government—which examined the cultural isolation of, and the lessons to be learned from, schools in Burnley and adjoining Blackburn? The report was counter-intuitive, but it would now be extremely helpful in going forward.

Michael Gove: I am very grateful to the right hon. Gentleman. I think that he is referring to the Cantle report, which we have looked at in the past. Certainly, there is a body of work that helps us to understand some of the challenges of separate communities and of how to secure better integration.
	On the question of the curriculum, the one thing I would say is that I am confused about Labour’s position on the national curriculum. Labour Members seem to want to extend it to all schools, but the shadow Secretary of State has said that all schools should have the ability to opt out completely from it. I appreciate that the right hon. Gentleman has the benefit of experience and that the shadow Minister does not, but until we get a consensus view from the Labour party I will listen to Sir Michael Wilshaw.

Margot James: As the hon. Member for Birmingham, Edgbaston (Ms Stuart) said, these findings would be unacceptable in any school—secular or faith, state or independent. This affront to British values may well extend to other schools outside the area that Ofsted has already inspected. Will my right hon. Friend ensure that there is no hiding place in any part of the British education system for the misogyny and homophobia that underpin so much of the religious fundamentalism in some of our schools?

Michael Gove: My hon. Friend makes a very important point. Inevitably, there was only so much I could say in the time allocated about the weaknesses in the schools identified. She homes in on one problem, which is that children who are at risk of being exposed to extremist views are often at risk of being exposed to views that are fundamentally offensive to those of us who believe in the equality of all human beings. Therefore, if there are concerns—anywhere in this House or outside—about children being exposed to those views or at danger of being exposed to those views, I hope that individuals will feel able to contact Ofsted using the new whistleblowing framework outlined by Sir Michael Wilshaw to ensure rapid investigation.

Jack Dromey: All faiths should subscribe to universal human values and universal human rights, including equal treatment of men and women. Where there is clear evidence in our
	schools of unacceptable practices, as there is in the case of a small minority of schools in Birmingham, it should be dealt with decisively. However, does the Secretary of State accept that it is important for politicians to act responsibly, and that it is wrong to use inflammatory language or to take steps that send the wrong message? To that end, what were the grounds for appointing a former of head of counter-terrorism to investigate Birmingham’s schools, and was it wise to do so?

Michael Gove: It was absolutely wise to appoint Peter Clarke to his role as commissioner. It is important to stress that he is looking at some of the wider allegations that were raised in the Trojan horse letter. Some of the allegations in the letter appear to be unfounded; others appear to be supported by the evidence that we have gathered. We need to make sure that Birmingham city council and every agency have the capacity necessary to keep children safe.
	It is important to recognise that Peter Clarke has not just the investigative capability but the experience of working with the Charity Commission to ensure that public funds are properly used and that the public are properly protected. If the hon. Gentleman has any concerns about the integrity, probity or authority of Peter Clarke, he should please bring them to me. The time has come to recognise that the situation in Birmingham is sufficiently serious that a public servant of Peter Clarke’s skill is exactly the right person to investigate.

Rob Wilson: I listened intently to the lengthy contribution of the shadow Secretary of State. I worry that he has developed political amnesia. As we have heard, the roots of the issue in Birmingham run deep and include Birmingham city council. Will the Secretary of the State assure the House that Peter Clarke will look fully at the allegation that the previous Government failed to act on a report of an attempted hard-line Muslim takeover of a school in Birmingham as far back as 2008?

Michael Gove: My hon. Friend makes an important point. I will stress two things. First, the permanent secretary will look to see exactly how the Department responded to warnings before and after the formation of this Government. Secondly, as my right hon. Friend the Home Secretary pointed out, before 2010, a number of individuals who were associated with extremist views and organisations were supported by public funds or invited to advise the last Government on anti-extremism. That does not happen under this Government as a result of her leadership. It would be gracious of the hon. Member for Stoke-on-Trent Central (Tristram Hunt) to acknowledge the leadership that the Home Secretary has shown and the improvement in our counter-extremism strategy as a result.

Keith Vaz: I have no objection to no-notice inspections. They have worked in other areas. Will the Secretary of State confirm that there is no evidence before him of this kind of activity taking place in other areas of the country, and that his support of faith schools remains unshakeable? May I also put to him the question that the Home Secretary asked me to put to him? Has he replied to her letter of 3 June and answered the four important questions that she put to him?

Michael Gove: I believe that my statement today provides a full response to all the concerns that were raised in the letter in respect of Birmingham city council’s failure in the past, on which Sir Michael Wilshaw has reported, and the warnings that my Department was given in 2010. I am also delighted to reinforce my support not just for faith schools, but for free schools that have a faith ethos, such as the outstanding Krishna Avanti primary school in the right hon. Gentleman’s constituency, which I had the pleasure of opening. I underline the request for him or any other Member of the House who has concerns about extremism in any part of the country to please bring them to my attention and the attention of Ofsted. The hon. Member for Bradford East (Mr Ward) has brought concerns to my attention about issues in Bradford. I am pleased to say that the Labour local authority in Bradford is currently dealing with those.

Lee Scott: We are hearing about the despicable things that have happened in Birmingham and it is quite right that they should be investigated, but I have a slight concern. Does my right hon. Friend agree that we have some of the best education in faith schools of all religions across this country, and that we must not condemn all faith schools just because of something that might have happened in one area?

Michael Gove: My hon. Friend is absolutely right. It is one of the pleasures of my job to visit voluntary aided schools and schools with a faith ethos that do an outstanding job of respecting the religious beliefs of children and making sure those children are fit for a life in modern Britain. It is important to stress that none of the schools that we are talking about are faith schools. One of the issues is that they are secular schools that governors have sought to turn into faith schools of a particular narrow kind in a way that is unacceptable.

Lisa Nandy: Since the Secretary of State took on his job, he has limited local accountability and Ofsted oversight, and has fought attempts to publish the costs and funding agreements of schools and to reveal who is advising those schools and his Department, and on what basis. Given that he has fought openness and transparency from his Department tooth and nail, will he tell us, following the recent appalling events, whether he understands the importance of transparency to education and whether his Department will operate on a completely different basis from now on?

Michael Gove: I understand the hon. Lady’s point. She has taken the opportunity of this statement to raise one or two other questions. I believe absolutely in the importance of openness and transparency. I also think that it is important that the advice that is given by officials in confidence to shape ministerial decisions is protected as a safe space. I also agree that it is vital that when we discover things that have gone wrong in the education system, as is shown by the reports today, we publish in full.

Stuart Andrew: As co-chair of the all-party parliamentary group on Islamophobia, may I say that we have heard time and again from the community about its desire to tackle extremism? We have also heard evidence that the news coverage of issues such as this
	one, if they are reported wrongly, can increase feelings of insecurity, suspicion and alienation. In some instances, the wrong type of language has been used. Does my right hon. Friend agree that we need to do everything we can to help the community, and that accurate reporting of the established facts is really important?

Michael Gove: I could not agree more. We must proceed on the basis of facts and evidence, and ensure that that evidence is rigorously assessed and judged fairly. My hon. Friend makes an important point about Islamophobia. I tried in my statement, and I will try on every platform I am given, to emphasise the fundamental difference between Islam as a great faith that brings spiritual nourishment to millions and inspires daily acts of generosity by thousands, and the narrow perversion of that religion, which is extremist Islamist ideology.

Diana Johnson: The Government fund Prevent co-ordinators in 30 local authorities where there is a perceived view of extremism. What work does the Secretary of State expect those co-ordinators to do in local schools? Over the past year how many reports were made by those co-ordinators to his Department?

Michael Gove: I salute the work of Prevent co-ordinators. Immediately after these concerns were expressed, Birmingham city council sought funding from the Home Office for an additional Prevent co-ordinator to work with schools, which my right hon. Friend the Home Secretary authorised. A Prevent co-ordinator from east London has now joined Ofsted to ensure that all Ofsted inspectors who deal with issues of this kind are trained to deal with the signs of extremist, Islamist ideology. I am, of course, more than happy to work with the hon. Lady and others to ensure that we augment the good work of those Prevent co-ordinators who have been successful in dealing with problems of that kind.

Duncan Hames: The Secretary of State began by describing keeping children safe and preparing them for life in modern Britain as his Department’s central mission. Is he satisfied that he has the means to ensure that that happens, whether or not their school is funded by the taxpayer?

Michael Gove: That is a very good point. Today we have outlined that we plan to consult on independent school standards, so that schools that are not funded by the taxpayer must meet basic standards of promoting British values, or the Education Secretary will have the capacity to close them down. We are also taking steps to work with the Association of Muslim Schools UK to see what more can be done.

Toby Perkins: The Education Secretary either omitted or did not get the opportunity fully to respond to the question from my hon. Friend the Member for Stoke-on-Trent Central (Tristram Hunt) about Park View. For the sake of clarity, will he explain why Park View was not allowed to open a free school but was allowed to sponsor Golden Hillock to become an academy?

Michael Gove: Before any free school can be opened a very high bar must be cleared. A separate set of criteria were judged in this case, and the Minister responsible decided that for that specific free school application, the bar was not cleared.

George Freeman: I warmly welcome my right hon. Friend’s statement, in particular his commitment to put the promotion of British values at the heart of what every school must deliver for children. Does he agree that the reason this country has been able to offer sanctuary to people from around the world of different races and faith for so long is precisely because of a simple covenant of citizenship: “Come here, speak our language, respect our heritage and values and you are welcome”?

Michael Gove: I absolutely agree. One strength of the United Kingdom is that it has provided a safe and warm home for people of every faith over hundreds of years. It is critical that we ensure that our traditions of liberty and tolerance are protected so that everyone, whatever their background, can feel that sense of pride in this nation and allegiance to other citizens, which all of us would want to celebrate as the best of British.

Bill Esterson: Thousands of schools report directly to the Secretary of State with no formal opportunity for local oversight. Will he accept that what happened in Birmingham shows how important it is to have full local oversight? That is the only way to look after the interests of all children and young people in our schools up and down the country.

Michael Gove: I agree that local representatives, whether in local authorities or as local MPs, should play a part in helping to ensure that children are safe. It is also important to recognise that the local authority in this case failed in the past, and that when the specific allegations in the Trojan horse letter were shared with the Department for Education, it was rapid in seeking to deal with those problems and ensuring that appropriate inspection and action was taken.

Sarah Wollaston: I welcome the decisive action taken by the Secretary of State today and the consultation on the promotion of British values. Does he agree that a very clear British value is that young girls and women should be seen and heard in the classroom, not relegated to the back of the room? Will he consult specifically on whether we will be teaching them the communication skills and confidence they need if they are hidden, in our schools and colleges, behind a niqab or burqa?

Michael Gove: My hon. Friend makes a very important point. One of the concerns raised in several reports was what appeared to be unacceptable segregation in the classroom. Another point I would make is that there are real questions about how sex and relationships education was taught in some of these schools. It is vital that schools should be places where young girls find their voices, rather than feeling that they are being silenced.

Mike Kane: As a former teacher, I welcome the Secretary of State’s defence of faith and faith-based schooling. However, I believe that the atomisation of our schooling system is a problem. Does he not concur that a greater form of solidarity between local schools would help to self-police this type of extremism?

Michael Gove: The hon. Gentleman makes a very important point. We are seeing a level of collaboration between schools—through teaching school alliances,
	academy chains and informal partnerships—that is a very powerful driver of improved standards. It ensures that individual teachers, who may have concerns about what is happening in their own school, have access to a wider network of professionals who can help them to deal with the challenges they face.

Alun Cairns: Extremism in schools has, sadly, been going on for more than a decade. Will the Secretary of State reassure the House that Peter Clarke will have unfettered access to all paperwork going back over that period?

Michael Gove: I will do everything in my power—I hope every agency will—to help Peter Clarke in his job.

Graham Jones: One of the primary purposes of the investigation was to look at extremism, but what is the Secretary of State doing about extremism in places of education that do not fall within the responsibility of the Department for Education?

Michael Gove: The hon. Gentleman makes an important point. I infer from what he is saying that he is talking about further education colleges and perhaps even universities.

Graham Jones: Under-16s.

Michael Gove: On specific concerns about specific institutions for under-16s that do not fall within my remit, I infer from that that the hon. Gentleman is thinking about independent schools or even, possibly, supplementary schools. As far as independent schools are concerned, we are consulting on toughening independent school standards, as I mentioned to my hon. Friend the Member for Chippenham (Duncan Hames). In respect of supplementary schools, sometimes known as madrassahs, we will shortly publish a code governing how madrassahs should operate. At the moment, the plan is that the code should be voluntary, but I am, of course, open to debate and contribution in the House on how to make it as effective as possible.

Henry Smith: Yesterday I had the privilege of speaking at the opening of the new Langley Green mosque in my constituency, which was a multi-faith event. Does the Secretary of State agree that that illustrates the importance of inclusivity, which the vast majority of the Muslim community want in our education system, both in Birmingham and across the country?

Michael Gove: I am grateful to my hon. Friend for the active role he plays in ensuring that all the faith communities in his constituency are effectively represented and can contribute to modern Britain.

Nicholas Dakin: In an education landscape of university technical colleges, free schools and academies run directly from Whitehall, will the Secretary of State’s welcome review of what the Department has to learn include a thorough analysis of weaknesses in the current accountability system?

Michael Gove: I take the hon. Gentleman’s point. I think one of the things that is clear from the action that has been taken in schools today is that academies, and,
	for that matter, free schools, are subject to a higher level of accountability than local authority schools. One of the things I will be looking at is how we can ensure that local authority schools are held to a similar level of accountability in the future, not least for the discharge of public money.

David Ward: Will the Secretary of State tell us whether what has been discovered in Birmingham is confined to Birmingham? He will know of rumours of links between Birmingham schools and Bradford schools. Will he tell us whether it is sheer coincidence that Feversham college, a Muslim girls’ school that is one of the highest performing schools in the country, has been notified today that it will have an Ofsted inspection tomorrow?

Michael Gove: I would make two points. First, the original Trojan horse letter, which as we know contained a number of facts and allegations that proved to be unfounded, was allegedly a letter sent to individuals in Bradford. I am grateful to my hon. Friend for his support in alerting me to some potential concerns. I know that Bradford council has taken them seriously, and I look forward to remaining in touch with Bradford—and, indeed, any other local authority that has concerns. The Department for Education is there to support and help if, for example, governors need to be removed and an interim executive board put in place. Secondly, as for what he tells me about Feversham college, I have no prior warning of any Ofsted inspections, which are quite properly an operational matter for the chief inspector unless I specifically request an inspection because of information that has been passed to me.

Nia Griffith: The Secretary of State’s failure to pinpoint these problems sooner makes it absolutely clear that he cannot micro-manage schools from Westminster. Will he now consider adopting a policy akin to Labour’s proposal for local directors of school standards, which would enable schools to be more accountable locally and would help to flag up these types of problems a lot sooner?

Michael Gove: No.

Neil Carmichael: Noting that Ofsted has already put the spotlight on the quality of school leadership and management as part of the inspection, and recognising the Government’s focus on the skills of governing bodies rather than just on stakeholder representation, does the Secretary of State agree that that, combined with further accountability to the regional commissioners, will strengthen the resolve of councils to get rid of failing governors and is a step in the right direction?

Michael Gove: I entirely agree with my hon. Friend, who has shown brilliant leadership on the issue of improving governance. As well as all of his important points, there are some specific recommendations on strengthening governance from Sir Michael Wilshaw that recommend themselves to me.

Pat Glass: The Secretary of State will have heard my earlier question to the Home Secretary—one of many questions that she failed to answer this afternoon, so I am going to ask him the same question. We know of the correspondence between
	his Department and other agencies about these issues in 2010. When did he become aware of it, and what has gone so wrong in his Department that it has taken an anonymous letter in 2014 to get action on something that it knew about in 2010?

Michael Gove: I am grateful to the hon. Lady for raising that issue. If she will share that correspondence with me, I will share it with the permanent secretary and write back to her.

Crispin Blunt: The Secretary of State has reported Ofsted’s concern that governors are trying to impose a narrow faith-based ideology on what are non-faith schools, but that is also not in the public interest in faith-based schools, and surely it is part of the purpose of faith schools to deliver a faith-based ideology. Since we have had three decades of unhappy experience of violent division in Northern Ireland being reinforced by state-funded, faith-based education, is it not now about time that we asked people, if they want to exercise the freedom to have a faith-based education for their children, not to expect the rest of us to pay for it because it is not in the public interest?

Michael Gove: I am grateful to my hon. Friend for his point. In the light of what has been revealed, it is important to have a debate about the proper place of faith in education, but I have to say that I respectfully disagree with him. I think that the role of a number of faith institutions from a variety of faiths in education has been all to the good.

Chris Bryant: Of course we must draw an important distinction between devout conservatism—whether it be Catholic, evangelical, Christian or Muslim—on the one hand, and extremism on the other hand. But has not all of this shown that the Achilles heel in the Secretary of State’s education policy is that there are more and more schools now in which there are fewer and fewer means of preventing fundamentalist indoctrination?

Michael Gove: I do not accept that that is the case. If we look at the problems identified, I believe that they arose well before this Government were formed, and that it is as a result of this Government—and, in particular, as a result of the higher level of accountability that exists in academies and free schools—that we were able to take the exemplary action that we did.

Tony Baldry: In Birmingham and across the country, thousands of men and women are giving valuable voluntary service to act as school governors. Will my right hon. Friend explain what happens if there is a suspicion that a school governor is promoting extremism and what statutory powers there are in those circumstances to remove a school governor from an LEA-controlled school or an academy?

Michael Gove: We are consulting on how we can ensure that we can remove governors if there is any suggestion that they have been involved in extremist activity in independent schools, and also extend that power in order to bar them from serving as governors in any local authority schools in the future.

Huw Irranca-Davies: The Secretary of State has provided a welcome clarification today by stating that he was not at the 2010 meeting at which Tim Boyes gave his presentation, and I am sure that he can extend the same clarification to any of his ministerial colleagues. However, as a former Minister, I know that action points will have been made at that meeting. Given the importance of this matter, will the Secretary of State now agree to publish those action points—without jeopardising the integrity and confidentiality of individual civil servants—and reveal what arose from them? Was any action taken?

Michael Gove: That is a fair question. Let me say two things to the hon. Gentleman. First, I have asked the permanent secretary to look at our responses to all the warnings that the Department has received, and I think that it would be premature for me to release anything before he has finished his report. Secondly, I have described—both in my statement and in my response to what was said by the hon. Member for Stoke-on-Trent Central (Tristram Hunt)—some of the actions taken by my Department which have provided it with a more robust set of tools to deal with extremism than have been available before.

Nadhim Zahawi: The Secretary of State has described some shocking behaviour—shocking not only to Muslim parents, but to all parents. Does he agree that the failure of Birmingham city council to deal with this problem over a long period demonstrates the importance of the academies programme, which takes powers away from politicians and bureaucrats and hands them to teachers?

Michael Gove: My hon. Friend has made an important point. Some of the most outstanding schools in Birmingham are currently academies and free schools. Indeed, the hon. Member for Stoke-on-Trent Central has previously praised Liam Nolan, the head teacher of Perry Beeches school, who runs an academy chain and has opened free schools. I think that the hon. Gentleman’s attempt to conflate the growth of academies and free schools—and the consequent improvement in school standards—and a risk of extremism constitutes an attempt to jump on an opportunistic bandwagon, which, sadly, is becoming a characteristic of his approach to opposition.

Christopher Pincher: On 6 June, Labour’s police and crime commissioner for the west midlands, Bob Jones, issued a press release on Trojan horse which many believe ignores the dangers of extremist teaching in schools. Given that, under Mr Jones’s leadership, the West Midlands police have been criticised by Ofsted for consistently failing to attend more than 50% of child protection meetings—indeed, at one stage attendance was down to 9%—does my right hon. Friend agree that that is one example of local oversight and accountability that certainly needs to be improved?

Michael Gove: My hon. Friend has made a very good point. I have been disappointed by some of the comments made by the west midlands police and crime commissioner. I hope that today, following the publication of the reports, the commissioner will have an opportunity to reflect, to think again, and to discharge his responsibilities more effectively.

Jonathan Ashworth: On Friday, in my constituency, I was approached by some Muslim parents and, indeed, Muslim teachers who were very concerned about the tone of this debate, and who felt that the Muslim community were being branded as extremists. Does my right hon. Friend agree that all of us who are involved in the debate should be cool-headed and avoid using incendiary language such as “Islamist plots”—when such plots do not appear to exist—and “draining the swamp”? Does he also agree that many state schools with a high proportion of Muslim students, and indeed Muslim faith schools, offer a good, well-rounded education?

Michael Gove: I entirely agree with the hon. Gentleman.

Peter Bone: The hon. Member for Rhondda (Chris Bryant) made a very fair point about faith schools that want to teach conservative religious values. How do the Government distinguish between such schools and schools in which extremism is happening?

Michael Gove: Clear requirements apply to all voluntarily aided faith schools. They are, of course, allowed to make provision for appropriate worship and for freedom of conscience, but they must also offer a broad and balanced curriculum, as has always been the case. They must also respect British values, and, as a result of the proposals on which I intend to consult from today, they will always be required to promote those values actively in the future as well.

Alex Cunningham: In the light of what we have learned today, does the right hon. Gentleman agree with what appears to be the Home Secretary’s view—that there is no real need to increase spending on anti-extremist programmes?

Michael Gove: I totally agree with the Home Secretary and I think that her leadership on counter-extremism has been exemplary.

David Nuttall: Does my right hon. Friend agree that the findings of these reports demonstrate the need to ensure that there is a breadth of views on school governing bodies? One way of achieving that is to ensure that there are governors of different faiths on governing bodies and that they are encouraged to take a proactive role so that pupils receive a balanced education.

Michael Gove: My hon. Friend makes a characteristically acute and pertinent point.

Rehman Chishti: I welcome what the Secretary of State is doing in this area. I was appalled by some of the report’s findings, particularly the comment by Sheikh Shady al-Suleiman, where he distorted the concept of jihad and linked it to Afghanistan, which is often used by extremists to recruit people to radicalisation. Linked to that, does the Secretary of State agree that Sunday schools at places of worship should also be encouraged to teach British values and that sermons should be taught in English and not simply in Urdu or Arabic, to ensure that distortion is tackled?

Michael Gove: My hon. Friend makes a number of important points. He is right that the concept of jihad in Islam is a complex one and that it is possible to talk about it as a form of internal struggle. However, in the reported comments of Sheikh Shady al-Suleiman, it is clear that he is not using jihad in that context. My hon. Friend raises broader questions about how we deal with supplementary schools and Sunday schools in madrassahs. We will consult on how to deal with those.

Therese Coffey: I understand that my right hon. Friend has already introduced standards that allow the teaching of extremist views to be barred. Will he also advertise whistleblower lines more widely, so that teachers and parents can contact the Department for Education directly?

Michael Gove: My hon. Friend makes an important point. We want to ensure that whistleblowers and others who have concerns can contact Ofsted in particular, so that inspection can be swift and effective.

Debate on the Address
	 — 
	[3rd Day]

Debate resumed (Order, 5 June).
	Question again proposed,
	That an Humble Address be presented to Her Majesty, as follows:
	Most Gracious Sovereign,
	We, Your Majesty’s most dutiful and loyal subjects, the Commons of the United Kingdom of Great Britain and Northern Ireland in Parliament assembled, beg leave to offer our humble thanks to Your Majesty for the Gracious Speech which Your Majesty has addressed to both Houses of Parliament.

Health

Jeremy Hunt: The legislative programme presented to Parliament last week by Her Majesty the Queen builds on four years in which we have not shirked our duty to the British people to restore confidence in disastrous public finances; to lead the country from the deepest recession since the second world war to the strongest growth in the G7; and to implement a plan that secures our long-term economic future. As part of that programme, we have been following a long-term plan to transform our NHS and help it to meet the challenges of an ageing population. However, we must remember that without the difficult decisions made to restore faith in our public finances, the NHS would have been in a very different position.
	In Ireland, the health pay bill was slashed by 16% because it ran out of money. In Greece, health spending was cut by 20%. In Portugal, the public were asked to double their personal contribution to the cost of health care, but in England difficult decisions meant that we were able to protect the NHS budget, unlike the Labour party, which plans to cut it in England, and did indeed cut it by 8% in Wales, with disastrous consequences. Labour made the wrong call on the economy and the wrong call on NHS finances. Because we made the right call, the NHS is now doing extremely well in very challenging circumstances.
	Later, Members will hear the right hon. Member for Leigh (Andy Burnham) talk about operational pressures facing the NHS. He is right: it is tough out there. This week, we will announce new measures to help the service to meet the challenges that it faces. We will no doubt also hear attempts to politicise what are essentially operational pressures, but what we will not hear is how much better the NHS is doing than it ever did when he was Health Secretary. The facts speak for themselves. Every single day—[Interruption.] This is difficult for Labour Members to listen to, but they would do well to listen. Compared with when he was Health Secretary, every single day we are referring 1,000 more people with suspected cancers to specialists. We are transporting 1,000 more patients—

Andy Burnham: Will the Secretary of State give way?

Jeremy Hunt: I am going to make some progress and then give way. The right hon. Gentleman needs to listen. We are doing much more now compared with what was done when he was Health Secretary. If he listens, he might learn something.
	This is what is happening every single day: 1,000 people with suspected cancers are being referred, and 1,000 more patients are being transported in ambulances in emergencies. Every day we are performing 2,000 more badly needed operations, we are seeing 3,000 more vulnerable people in A and E departments, and every day we are providing around 6,000 more GP consultations for members of the public and 10,000 more vital diagnostic tests. At the same time, MRSA rates have almost halved, mixed-sex wards have been virtually eliminated, and fewer people are waiting for 18 or more weeks for their operation.

Andy Burnham: The Health Secretary is standing there claiming everything is fine and giving a litany of successes. Let us just consider cancer care. He said the NHS was worse when we were in government. So that we are absolutely clear, will he confirm that the last set of figures show that the NHS is now for the first time missing its standard of treating cancer patients within 62 days?

Jeremy Hunt: The right hon. Gentleman should have listened to what I said: I said he was right to say it is tough out there, and I also said that this week we will be announcing measures to help the NHS deal with operational pressures. He talks about how long people are waiting for operations, so let us look at one particular statistic that sums up what I am saying: the number of people waiting not 18 weeks but a whole year for a vital operation. Shockingly, when the right hon. Gentleman was Health Secretary, nearly 18,500 people were waiting over a year, and I am proud that we have reduced that to just 500 people. Those results would not be possible without the hard work and dedication of front-line NHS staff, and whatever the political disagreements today, the whole House will want to pay tribute to their magnificent efforts.

Andy Slaughter: Will the Health Secretary comment on the shambles he has reduced the NHS to in west London, where he is closing A and E departments, like that at Hammersmith on 10 September, while there are inadequate numbers of beds at the only hospital people have been directed to? It means that there is no acute care, and primary care is in such a state that there is an emergency in-year redistribution of money across north-west London. How is he going to sort that out?

Jeremy Hunt: What is happening in north-west London is going to make patient care better. It involves the seven-day opening of GP surgeries, over 800 more professionals being employed in out-of-hospital care, and brand new hospitals. That is a huge step forward, and the hon. Gentleman is fighting a lone battle in trying to persuade his constituents that it is a step backwards.
	This Government recognise the pressure that the NHS is under, as I was telling the shadow Health Secretary. The fact that the population is ageing means that the NHS now needs to perform 850,000 more operations every year than when he was in office, which we are doing. That means that some patients are not receiving their treatment as quickly as we would like, so NHS England is this week announcing programmes to address that, ensuring that we maintain performance
	while supporting the patients waiting longest for their treatment, something that did not happen when he was in office. We will not allow a return to the bad old days when patients lingered for years on waiting lists because once they had missed their 18-week target, there was no incentive for trusts to treat them.
	A and Es, too, are facing pressure and are seeing over 40,000 more patients on average every week than in 2009-10. NHS staff are working incredibly hard to see and treat these patients within four hours, and it is a tribute to them that the median wait for an initial assessment is only 30 minutes under this Government, down from 77 minutes under the last Government. However, as we did last year, we will continue to support trusts to do even better both by improving their internal processes and working with local health economies to reduce the need for emergency admissions. This will be led by NHS England, Monitor and the NHS Trust Development Authority.

David Davies: We have heard some comments from Opposition Members about waiting times. My right hon. Friend will be aware that fewer than 2% of patients in England wait for more than six weeks for diagnostic treatment, but is he aware that the figure is 42% of patients in the Labour-run NHS in Wales?

Jeremy Hunt: I am aware of those shocking figures, and I am also aware that the Royal College of Surgeons says that 152 people died on waiting lists in Wales at just two hospitals because they did not get their treatment in time. I gently suggest to the shadow Health Secretary that the Labour party might want to fix what is going on in Wales if it is really serious about patient care, because how Labour is running the NHS in Wales is an absolute disgrace.

Mike Gapes: rose—

Barbara Keeley: rose—

Jeremy Hunt: I am going to make some progress, and then I will give way.
	The NHS is about more than just getting through difficult winters. Looking to the future, this Government will continue to take the bold steps necessary to prepare our NHS for the long-term challenges it faces. There are two key areas for action if we are to rise to this enormous challenge. First, we must never turn the clock back on Francis. The NHS will never live up to its founding ideals if it tolerates poor or unsafe care. The last Government presided over an NHS in which doctors or nurses who spoke out were bullied, in which problems at failing hospitals were brushed under the carpet and in which vulnerable older people were ignored and, tragically, on occasions, treated with contempt and cruelty. This Government have stood up for the patient, championing high standards with a new culture of compassionate care which is now transforming our health and care system.

Alex Cunningham: The Secretary of State has already admitted some of his own failures this afternoon. Does he not think that some of the
	money he invested in his £3 billion reorganisation of the national health service could have been used to ensure that the NHS was hitting its targets today?

Jeremy Hunt: Perhaps the hon. Gentleman would like to look at the facts relating to the actual cost of the reorganisation. The net saving as a result of it has been more than £1 billion a year, and we are now employing 7,000 more doctors and 3,000 more nurses than when his party was in office. Last year, as a result of this programme—

Mike Gapes: rose—

Jeremy Hunt: I am going to make some progress.
	Last year, as a result of this programme, this Government put 15 trusts—

Mike Gapes: rose—

Jeremy Hunt: This might not be something the Opposition agree with, but they should listen. I need to tell the House that we have put 10% of all acute trusts into special measures, and that in each and every one of them the warning signs were there under the last Government. The George Eliot hospital, for example, had one of the worst mortality rates in the country back in 2005. Tameside had to pay £9 million compensation for mistakes in just two years, and at the Queen’s hospital in Romford in 2006, a lady gave birth in a toilet, leading to the tragic death of her child.

Brian H Donohoe: The Secretary of State will be aware of a problem that is affecting thousands of women. It relates to medical implant devices that a court in America has banned. What is he prepared to do to deal with the situation in this country that is affecting thousands of women, both north and south of the border?

Jeremy Hunt: The hon. Gentleman mentioned to me earlier that he was going to raise that point. I will look closely at the issue, as it sounds like an extremely important one.
	I want to look at what has changed under this Government. One of the trusts that has been in special measures is the Basildon and Thurrock University Hospitals NHS Foundation Trust. When the right hon. Member for Leigh was in office, inspectors at the hospital found blood stains on floors and curtains, blood spattered on trays used to carry equipment, and badly soiled mattresses. When the Care Quality Commission published those findings, it was allegedly leant on to tone down its press release. This Government put Basildon into special measures, and it now has 183 more nursing staff. I asked one of those nurses what the difference was. She said:
	“It’s very simple. When we raised a concern before, they weren’t interested. Now, they listen to us.”
	It gives me great pleasure to inform the House that the chief inspector of hospitals has today recommended that Basildon should be the first trust to exit special measures, and that Monitor has ratified that decision. The hospital has received an overall rating of “good” and has been praised for its excellent leadership. The chief inspector found that the trust had made significant improvements in a number of areas, including maternity
	services, which were rated as “outstanding”—
	[
	Interruption.
	]
	The Opposition might not care about what is happening at a trust in special measures, but we on this side of the House do.

Mike Gapes: On a point of order, Mr Speaker. The Secretary of State knows very well the issue I am trying to raise, because I raised it during the business statement last week. I want him to respond to an important fact. A leaflet was circulated in my borough on 20 May, two days before polling day. It was quoted in the local papers, and it related to the A and E department at King George hospital in my constituency. I simply want to ask him to confirm whether the announcement from the Secretary of State for Health referred to in the leaflet was made with his authority, or by him, during the week before polling day.

Mr Speaker: The hon. Gentleman is an ingenious and indefatigable Member. He probably knows that I can best describe that as an attempted point of order, because it is not a matter for the Chair. That said—[Interruption.] Order. That said, the hon. Gentleman has made his point forcefully, and it would certainly not be in any way disorderly for the Secretary of State to respond to it if he wished to do so.

Jeremy Hunt: I am most happy to respond to what—I agree with you, Mr Speaker—is a thinly disguised point of order. I will happily say this: what I said was completely in order because I was simply restating information publicly available on the trust’s website.
	I want to go back to talk about Basildon hospital, because of the remarkable turnaround there. Chief executive, Clare Panniker, and her term deserve huge credit for the changes that they have made, which will truly turn a corner for patients who depend on their services.

Mike Gapes: On a point of order, Mr Speaker.

Mr Speaker: Order. I ask the hon. Gentleman to calm himself for a moment. I accept the great importance of these matters, but I hope that this is a point of order rather than of frustration.

Mike Gapes: indicated assent.

Mr Speaker: The hon. Gentleman is nodding with great vigour and intensity. Let us hear the attempted point of order.

Mike Gapes: I want to be clear about what the Secretary of State just said. He said, “What I said was”. I seek your advice, Mr Speaker. How can I get clarification from the Secretary of State about whether he made an announcement during the purdah period in the days just before the election or whether it was a previous statement rehashed and reissued from weeks before?

Mr Speaker: The short answer to the hon. Gentleman is that he must use his best devices, both in this debate, where he might have an opportunity to catch the eye of the Chair later, and in Health questions, which, if memory serves me right, are coming up very soon—

Hon. Members: Tomorrow.

Mr Speaker: As I said, they are coming up very soon, and I am grateful to the hon. Member for Weston-super-Mare (John Penrose) for concurring with my suggestion that “very soon” does indeed include tomorrow. There will also be opportunities at all times for the hon. Member for Ilford South (Mike Gapes) to table questions with the advice of the Table Office. I have known him for 20 years and more, and he is not very readily put off his stride. I have no doubt that he will continue to gnaw at the bone until he achieves an outcome that he regards as satisfactory. Meanwhile, we must continue with the debate and the oration of the Secretary of State.

Jeremy Hunt: The decision to place 11 trusts into special measures last summer was not taken lightly, but we can see today that it was the right decision. Across the whole NHS, the number of people who think they would be safe in an NHS hospital is as high as it has ever been, the number of people who think that people are treated with dignity and respect has risen by six percentage points over the year and the number of people who think that people are treated with compassion has gone up by eight percentage points. This Government have introduced new chief inspectors of hospitals, general practice and adult social care to oversee the toughest, most transparent and most independent rating system of any country anywhere. We have improved accountability with a statutory duty of candour, and we are supporting staff by publishing ward-level nurse staffing levels for every trust.

Jackie Doyle-Price: rose—

Barbara Keeley: rose—

Jeremy Hunt: I will give way to my hon. Friend because she is affected by Basildon hospital.

Jackie Doyle-Price: I thank my right hon. Friend for giving way. I am sorry that his congratulations to Basildon hospital were so dreadfully interrupted earlier, because its journey since 2009, when real deficiencies were highlighted, to where we are now with the special measures being lifted is, as he has said, real testament to the leadership of the hospital’s new management and the commitment of the staff. I thank him for the impetus that he has given that process, because it is only by admitting when things go wrong that we can put them right; that is the difference between the Government and the Opposition.

Jeremy Hunt: I congratulate my hon. Friend for her work campaigning for higher standards at her local hospital, and I agree with her. Why is it that interventions to do with improving safety and compassionate care are coming only from Government Members and that the Opposition are not interested? I just challenge Labour Members on whether they are really on the right side of the big changes that need to happen in our NHS.

Several hon. Members: rose—

Jeremy Hunt: I am going to make some progress because we have had lots of interventions. [Interruption.] I am going to make some progress and I have been very generous. [Interruption.]

Mr Speaker: Order. There is now a kind of institutionalised rowdiness about this debate, epitomised by the hon. Member for Swansea West (Geraint Davies) on the third row. It would be seemly if he would calm himself. I do not refer to people outside this place, but this debate is being keenly attended by a large number of citizens, who would expect Members to behave in as seemly a fashion as I feel sure they do on a day-to-day basis.

Jeremy Hunt: Despite the amount of work that has been done in the past year, there is still much to do to improve safety and care. According to a study based on case note reviews, around 5% of hospital deaths are avoidable. That equates to 12,000 avoidable deaths in our NHS every year, or a jumbo jet crashing out of the sky every fortnight. On top of that, every two weeks, the wrong prosthesis is put on to a patient somewhere in the NHS. Every week, there is an operation on the wrong part of someone’s body. Twice a week, a foreign object is left in someone’s body. Last spring, at one hospital, a woman’s fallopian tube was removed instead of her appendix. Last summer, the wrong toes were amputated from a patient. This spring, a vasectomy was given to the wrong man. To tackle such issues, we need to make it much easier for NHS staff to speak out when they have concerns. We need to back staff who want to do the right thing, and we are currently looking at what further measures may be necessary to achieve that.
	Today, this Government vow never to turn back the clock on the Francis reforms, and I urge the shadow Health Secretary to do likewise when he stands up. Another vital set of reforms that we need to make if we are to prepare the NHS for the future involves the total transformation of out-of-hospital care. We know that prevention is better than cure and that growing numbers of older people, especially those with challenging conditions such as dementia, could be better supported and looked after at home in a way that would reduce their need for much avoidable and expensive care. This year, three important steps have been taken towards that vital goal. First, the new GP contract brought back named GPs for the over-75s—something that was so shamefully abolished by Labour in 2004. Older people often have chronic conditions that make continuity of care particularly important. However, Labour scrapped named doctors, and we are bringing them back.
	We are also acting to break down the silos between the health and social care systems with an ambitious £3.8 billion merger between the two systems. The better care programme is, for the first time, seeing joint commissioning of health and social care by the NHS and local authorities, seven-day working across both systems and electronic record sharing, so that patients do not have to repeat their story time after time and medication errors are avoided.

Barbara Keeley: The Secretary of State touches on a couple of issues, including safety, but ignores one of the most important ones, which is nurse-to-patient ratios. A safe patient-to-nurse ratio has been adopted at Salford Royal, and it could be adopted elsewhere. He is now talking about the better care fund. There is no new money in that fund, and if he is worried about pressure on the NHS, surely he should think about the £2.68 billion that is being taken out of adult social care. In my local
	authority of Salford this year, 1,000 people will lose their care packages. How is that good for alleviating pressures on the NHS?

Jeremy Hunt: Perhaps I can reassure the hon. Lady on those matters. First, the better care fund is the first serious attempt by any Government to integrate the health and social care systems and eliminate the waste caused by the duplication of people operating in different silos. The Government require all trusts to publish nurse-staffing ratios on a website that will go live this month. It is an important, radical change, and we are encouraging trusts to do exactly what she says is happening in Salford. It is important to say that, where other Governments have talked about integration, we are delivering it. We are doing one more important reform: we are taking the first steps to turn the 211 clinical commissioning groups into accountable care organisations with responsibility for building care around individual patients and not just buying care by volume.
	From next year, CCGs will have the ability to co-commission primary care alongside the secondary and community care they already commission. When combined with the joint commissioning of social care through the better care fund, we will have, for the first time in this country, one local organisation responsible for commissioning nearly all care, following best practice seen in other parts of the world, whether Ribera Salud Grupo in Spain, or Kaiser Permanente and Group Health in the US—[Interruption.]

Mr Speaker: Order. I say to the hon. Member for Rhondda (Chris Bryant), who has just published an extremely cerebral tome on the history of Parliament, that he should not be yelling and exhorting from a sedentary position as though he is trying to encourage a horse to gallop faster. It is not an appropriate way to behave.

Andrew George: The Secretary of State mentioned the importance of integrating secondary and primary care. He will be aware that the chief executive of NHS England recently addressed the large number of community hospitals with a sword of Damocles hanging over them and whether or not they will continue to exist. He said that that issue should be revisited and, indeed, has argued that community hospitals should be developed and that we should protect that area of care. Does the Secretary of State believe that the chief executive of NHS England is calling for the retention and reopening of community hospitals?

Mr Speaker: Interventions should be brief—the hon. Gentleman is experienced enough to know that.

Jeremy Hunt: I agree with the new chief executive of NHS England. There is an incredibly important role for community hospitals and, indeed, for smaller hospitals. He was making the point that it is not always the largest hospitals that have the highest standards. One reason why the public like smaller hospitals is that they are more personal, and very often the doctors and nurses know people’s names, which makes a difference. They are also closer to people’s homes and easier to get to for relatives wishing to visit people in hospital.

Several hon. Members: rose—

Jeremy Hunt: I am drawing to a close, so I shall continue by saying that a long-term plan for our NHS that recognises immediate challenges and the need to reform going forward is what the Government have put into practice. It is not easy to implement, but it is the right thing to secure its future, and the right thing for our country. When the right hon. Member for Leigh (Andy Burnham) rises to speak in a moment, he will say—he told The Independent that he would—that the NHS should have been included in the Queen’s Speech, ignoring the Bill to introduce additional child-care subsidies that will benefit thousands of NHS employees and ignoring the impact on NHS finances of the Bill to curb excessive redundancy payments—something for which his Government were largely responsible. He will not mention the straightforward security that the Government offer the NHS by sticking to a long-term economic plan that is working, so that we have the best possible chance to ensure that the NHS can be properly funded going forward.
	If the right hon. Gentleman does not address those points, I hope that he will use his speech to show that he has learned from some of the big challenges facing the NHS over recent years. Does he accept that, without the reorganisation of about 20,000 administrators, the NHS would not be able to afford 7,000 more doctors and 3,000 more nurses? Does he accept that, without restoring named GPs, we will not be able to offer the joined-up care to vulnerable older people that he claims to champion? Most importantly, will he say publicly that, without honesty about poor care—honesty that he has repeatedly criticised as running down the NHS—we would not now be turning round 15 failing hospitals such as Basildon? In that spirit, will he categorically retract his statement, as reported in the Health Service Journal last week, that mid-Staffs was a local failure whose significance for the NHS has been exaggerated by this Government? If he does not do so, I have to say that we disagree profoundly on the biggest change that our NHS needs. We can state that change in just three words: put patients first. It is what NHS staff want to do, and they all want support to do it, but it is simply not possible unless they have the administrative and political leadership that puts patients first in every policy, target and announcement. The Government are proud of our record on the NHS: proud of record levels of high-quality care given to record numbers of patients, proud of tough economic choices that enabled us to protect the NHS budget and, most of all, proud of 1.3 million NHS staff who work hard day in, day out, to make our NHS so remarkable. We will not let them or the country down.

Andy Burnham: Last week, the Secretary of State told the NHS Confederation that patient safety was crucial to the future sustainability of the NHS. Let me begin on a note of agreement. The Health Secretary is right to continue to send the clearest message to the NHS that patient safety must be its top priority. He knows that he has our support in introducing measures to implement the Francis report and, indeed, learning all the lessons from the terrible failings at Stafford hospital. A question arises that is perhaps more for the Government to answer than the right hon. Gentleman: why is the Secretary of State’s important priority not reflected in the Gracious Speech? It is approaching
	18 months since the publication of the Francis report, yet many of its recommendations are still to be implemented. The failure to make progress in this legislative programme undermines the Secretary of State’s message today.
	The Francis report recommended new legislation to modernise the regulation of doctors and nurses and speed up the handling of complaints. The regulatory bodies said that progress is urgently needed, and they were expecting a Bill in the Gracious Speech to implement those reforms. Not surprisingly, both reacted negatively to the decision to drop it. Niall Dickson, chief executive and registrar of the General Medical Council, said:
	“We are disappointed that the government has not taken this opportunity to improve patient safety”,
	and Jackie Smith, chief executive and registrar of the Nursing and Midwifery Council, said:
	“Both the NMC and the public it protects now continue to be left, indefinitely, with a framework that does not best serve to protect the public.”
	I hope the Secretary of State will explain why that Bill was dropped and answer the concerns of Jackie Smith and Niall Dickson.

Jeremy Hunt: The right hon. Gentleman said he would start on a note of consensus on the Francis report, so does he now retract his comments last week that what happened at Mid Staffs was “a local failure” and that the Government were exaggerating its significance for the rest of the NHS? That was a very damaging thing to have said.

Andy Burnham: The Francis report found that the failing at Stafford hospital was principally a failure of the local board. I served in the previous Government, who inherited problems from the preceding one—care failings at Bristol royal infirmary and Alder Hey, and the Shipman murders. Contrary to what the Secretary of State said today, we took action to act on those failures and bring more transparency to the NHS. We introduced independent regulation to the NHS. He needs to look at the statements that he has made over the past year and consider whether his response has always been appropriate. He has used language such as
	“Cruelty became normal in our NHS”—[Official Report, 19 November 2013; Vol. 570, c. 1097.]
	Does he stand by such statements and does he think that is fair to the thousands of NHS staff who give their all every day, doing their best to serve patients?

Jeremy Hunt: rose—

Andy Burnham: I will give way to the right hon. Gentleman once more, but he needs to answer those concerns of staff, who feel that he has been running down the NHS.

Jeremy Hunt: Let me be absolutely clear. I have never blamed NHS staff for what happened at Mid Staffs. I blame the policy failures of the right hon. Gentleman’s Government. It is not just I who say so. Robert Francis said in his report:
	“Stafford was not an event of such rarity or improbability that it would be safe to assume that it has not been and will not be repeated”
	in the rest of the NHS. He continued:
	“The consequences for patients are such that it would be quite wrong to use a belief that it was unique or very rare to justify inaction.”
	Will the right hon. Gentleman now retract his comment that this was “a local failure” whose impact has been exaggerated?

Andy Burnham: I am quite clear what I said. I said that the finding of the Francis report was that it was a local failure, but of course there were lessons to be learned. That is why I brought in Robert Francis in the first place to begin inquiries at Stafford. The claim that we just brushed everything under the carpet could not be more wrong. The Secretary of State needs to drop it and start dealing responsibly with these issues.
	The right hon. Gentleman wanted to distract the House from what I was saying—that a Bill should have been brought forward in this Gracious Speech to modernise professional regulation in the NHS. I quoted strong sentiments from Niall Dickson and Jackie Smith. There was no room for such a Bill, but it is hard to find measures in the rest of the Gracious Speech that may be considered more important than that Bill. The Speech found space, for instance, for measures on pubs and plastic bags, but not on patient safety. There was a time when the Prime Minister used to say that his priorities could be summed up in three letters—NHS. Not any more. Those letters did not appear in the Gracious Speech and received only a cursory mention when the Prime Minister addressed this House.
	So what explains the relegation of health down the Government’s list of priorities? One commentator writing last Thursday offered an explanation. He said that
	“there was no mention of the health service in the Queen’s Speech. Indeed, the Tories have had little to say on the subject at all recently.
	I’m told that there is a precise reason for this: Lynton Crosby has ordered them not to.”
	I do not know whether that is true, but it does not look good, does it? It creates the clear impression that the shape of the Gracious Speech had more to do with the political interests of the Conservative party than the public interest of the country.

Barry Sheerman: Is not another explanation for the absence of any mention of the NHS in the Queen’s Speech that the Government do not want it? They are quietly privatising the NHS by the back door, so they do not need legislation.

Andy Burnham: I think that that is exactly the reason. They introduced a reorganisation that nobody wanted, that nobody voted for, that put the wrong values at the heart of the NHS and that has dragged the NHS down, and all the while they are softening it up for accelerating privatisation. That is the record on which they will have to stand before the country in less than 12 months’ time. If the Secretary of State can justify that record and breaking the coalition agreement to his constituents, I would be very surprised indeed.

Alun Cairns: Will the right hon. Gentleman give way?

Andy Burnham: No, I am going to make some progress.
	On the day of the Gracious Speech, 60 senior NHS leaders wrote to a newspaper to warn
	“that the NHS is at the most challenged time of its existence.”
	Just when it needs real leadership, it is being offered a period of drift from an increasingly dysfunctional Government and, sadly, the same is true on public health. The Government should have used this moment to regain the initiative and publish regulations on standardised packaging for tobacco and smoking in cars. Ministers announced on 3 April that they would publish the draft regulations on standardised packaging later that month—that was what the Minister responsible for public health, the hon. Member for Battersea (Jane Ellison), said. They have not, and since then almost 40,000 children have taken up smoking.
	The public health Minister wrote to my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), the shadow public health Minister, saying
	“we will now push ahead”
	with banning smoking in cars following the vote in this House, but we are still waiting. We did not hear anything on public health from the Secretary of State today. When will they show some leadership and set out a timetable for these important measures?
	It is not hard to guess the reason for this pre-election period of NHS silence. On every measure that matters to the public, contrary to what the Secretary of State said, the evidence is clear that the NHS has gone downhill under this Government and that it is getting steadily worse.

Geraint Davies: On the subject of preventive measures, my right hon. Friend might be aware that in Britain today child mortality among those below the age of five is the worst in the western world bar Malta, at one in 500? Washington university explains the cause as the welfare and austerity changes—food banks and the like. Will he comment on the impact of some of the welfare and other changes that have made the very weakest weaker, poor and unhealthier and are making them die earlier?

Andy Burnham: It is well documented that the policies of this Government in a range of areas are damaging the health of the nation, but what we get instead is drift from the Government on public health. There is no momentum at all to improve children’s health and the Queen’s Speech had absolutely nothing to say on it. Where are the measures that the Minister has been proposing? What has she been doing? Why does she not introduce them?

Jane Ellison: The right hon. Gentleman will be aware that the legislation for both the measures to which he alludes has already been passed by this House.

Andy Burnham: But regulations are needed. If the Minister does not know that—[Interruption.] It was the Opposition who brought forward the vote on smoking in cars and she committed to introduce regulations to implement it. She cannot duck the question. When will she do that? If she does not realise that she is going to introduce regulations, she needs to go back and do a bit more homework.
	It is not hard to guess why the Government want a period of silence. On every measure, the evidence is clear that the NHS is getting worse. When the Prime Minister was challenged—

Alun Cairns: rose—

Andy Burnham: No, I will not give way. When the Prime Minister was challenged on the wisdom of his reorganisation, he said that it should be judged by its effect on waiting times—[Interruption.]

Alun Cairns: rose—

David Davies: rose—

Mr Speaker: Order. The shadow Secretary of State is clearly not going to give way at the moment.

Andy Burnham: The Prime Minister set his own test for his reorganisation: its effect on waiting times. This month, waiting times hit a six-year high. Almost 3 million people are now on the waiting list for treatment, up by half a million since 2010, but that is not all.

David Davies: On a point of order, Mr Speaker. The shadow Health Secretary does not seem to want to give way to anybody from Wales. Is there any reason for that, and could it be a case of discrimination of some sort?

Mr Speaker: I am always interested in the ingenious interventions of the hon. Gentleman, but that is not a matter for the Chair and I will not speculate on it or in response to the hon. Member for Swansea West (Geraint Davies). We will return to the shadow Secretary of State.

Andy Burnham: I just gave way to somebody from Wales. What is the hon. Gentleman on about?
	That is not all. As I said before, the NHS is now missing its standard to ensure that cancer patients start their treatment within 62 days. That will cause huge distress to thousands of families up and down this country.
	Another way in which the NHS has got worse, and every patient knows this to be true, is that it is becoming harder and harder to get a GP appointment. It is a common experience for people to ring their surgery early in the morning only to be told that there is nothing available for days. A survey has found that almost half of GPs predict that the average waiting time will exceed two weeks by next year.
	The clearest measure of growing problems in the NHS is what has been happening in A and E, which is the barometer of the whole health and care system. Problems or blockages anywhere in the health and care system will manifest, in the end, as pressure in A and E. If A and E is the barometer, what is it telling us? It is warning of severe storms ahead. Hospital A and E units have now missed the Government’s target for 46 weeks running. For the last four weeks, the NHS overall has missed the Government’s target, suggesting that the winter crisis has now been followed by a summer crisis.
	Why is that happening? The fact is that cuts have been made to general practice, social care and mental health, which are pushing more and more people towards the acute hospital and placing it under intolerable pressure. Today, many hospitals are operating way beyond safe bed occupancy levels, and not surprisingly this is taking a toll on A and E staff. Today, we reveal that three times as many A and E consultants left the NHS in 2013, raising the worrying prospect of A and E now being trapped in a downward spiral.

Barbara Keeley: I thank my right hon. Friend for giving way. May I just take him back to the point about GP access, because that is the start of the patient’s journey? In our survey in Salford, we did not find the situation that we had under the Labour Government, where 80% of patients could get an appointment within 48 hours. Now only half our patients can get an appointment within 48 hours, with one in seven having to wait more than a week, which is concerning, and one in five unable even to get through to speak to someone in their GP surgery. This is concerning us in Salford because these are people who may have worries—they may even have cancer and need tests—and they cannot get through to their GP.

Andy Burnham: My hon. Friend is absolutely right—the deterioration in general practice has been marked during the past few years. There have been changes that have disadvantaged patients. Within weeks of taking office, the Government removed the guarantee that patients could have an appointment within 48 hours. That explains the situation that my hon. Friend describes, alongside cuts to funding of general practice to the point that some practices now say they are on the brink of deciding whether or not they can remain open. The Government have responsibility for that situation, but there is not a word from the Secretary of State about it and there is not an acknowledgement that people have severe problems in accessing their GP.

Tom Blenkinsop: In my constituency, the minor injuries unit at Guisborough hospital, the minor injuries unit at East Cleveland hospital in Brotton, a walk-in centre and medical centre in Skelton, and a medical centre in Park End—all primary or intermediary level facilities—will be closed, putting further pressure on the excellent but already outlying A and E unit at James Cook University hospital. When I write to Ministers to ask questions and for a meeting, I am told that I have already had too many discussions with them and that I cannot bring it up any further. Will my right hon. Friend please enlighten me about what he would do if were in power?

Andy Burnham: I will move on to that point. Whenever there is a problem, we are told, “Speak to NHS England.” I am afraid that is not good enough. Up and down the country we are seeing services closed without adequate consultation. NHS walk-in centres continue to be closed, piling more pressure on A and E departments. It is just not good enough. We have seen top-down changes driven through, and the hospital closure clause is on the books, so sadly this will continue.
	It will only change when we have a Labour Government back in control—a Government committed to putting the public and patient voice at the very heart of the NHS.
	I was talking about A and E and the reorganisation. We know that Ministers were explicitly warned about an A and E recruitment crisis by the College of Emergency Medicine a couple of years ago, but they said they were too absorbed with the reorganisation to listen or act. That brings me to the nub of the matter before the House: the root cause of the deterioration in the NHS is that reorganisation, which nobody wanted and nobody voted for. It threw the service into chaos just when it needed stability. As we warned, it has damaged standards of patient care. Four years ago the Government inherited a self-confident and successful NHS, with the lowest ever waiting times and the highest ever public satisfaction. Since then it has been destabilised, demoralised and reduced to an uncertain organisation that is increasingly fearful of the future.

Therese Coffey: The right hon. Gentleman refers to cuts in funding. The only cuts in funding that we have seen in this country have been in the NHS in Wales. With regard to patient satisfaction, I can assure him that the targets left behind by the previous Labour Government did nothing to satisfy patients who were left on the ground by ambulance services because they had already gone past the eight or 19-minute limit. I am afraid that the focus on targets, rather than patients, is something that this Government have had to address.

Andy Burnham: I think that it would behove Government Members to have a bit more self-reflection and humility. The hon. Lady was not a Member of the House at the time, but she may recall that before 1997 people used to spend years on NHS waiting lists, and some never came off them. Over Labour’s 13 years in government we saw waiting lists come down, and down, and down, to the point that, when we left office, they were at their lowest ever level. I am not claiming that the NHS was perfect and did everything right, but it had the highest ever level of public satisfaction. We must have done something right. A bit of balance and accuracy in this debate is just what the NHS needs.

Alun Cairns: rose—

Barry Sheerman: rose—

Andy Burnham: I give way to my hon. Friend.

Barry Sheerman: Does my right hon. Friend agree that this destabilisation has reached such an extent that very good hospitals, such as those in Huddersfield and Halifax, have a cloud over them because they might lose their A and E departments? What does that do for morale and culture, which have been so good in those two hospitals? Up and down the country, morale has been shaken to the roots.

Andy Burnham: What I find surprising is that all over the country plans are being developed to close A and E departments. How can that make sense when we are in the middle of an A and E crisis? In west London my
	hon. Friend the Member for Hammersmith (Mr Slaughter) has done much work to raise concerns about the changes to hospitals there.

Alun Cairns: Will the shadow Secretary of State give way?

Andy Burnham: The question I would put to the Secretary of State is this: have the Government looked at the latest evidence? Are they looking at the fact that this year hospital A and E departments have missed his target for 46 weeks? If that is the case, is it safe to proceed with changes on this scale?

Alun Cairns: On a point of order, Mr Speaker. I seek your advice. I am trying to raise a relevant point with the shadow Secretary of State. I want to point out that A and E waiting times in Wales have not been hit since 2009—

Mr Speaker: Order. The hon. Gentleman must not use an attempted point of order to try to make a point that he would make in the debate if he got the chance to contribute. He said that he wanted my advice. My advice to him is that persistence pays and he should keep at it, as I am sure he will.

Andy Burnham: I will give way to the hon. Gentleman before the end of my speech, but not now; I will do so when I am ready, because I want to develop my point, which is this: a successful NHS was thrown into chaos by reorganisation. Four years after Lansley’s big bang, the dust has still not settled. People out there are struggling to make sense of the 440 NHS organisations that have replaced the 163 that the Government inherited. They cannot make it all fit together and so are still sweeping up the mess. It was always nonsense to commission local GP services from a national level. To correct that, NHS England is now suggesting a new round of structural changes. This is the reorganisation that never ends. It is now rumbling into the fifth year of this Parliament. In fixing one problem, I fear the Government are going to create another—a local conflict of interest with GPs commissioning GPs. The truth that they do not like to face is that the former Health Secretary presented a defective and confused plan, and they now know, in their heart of hearts, that instead of pausing it, as they did, they should have stopped it altogether. They did not, and however much they tinker it will never make sense.
	That is why the only Bill in the Gracious Speech with any link to health is the one that tries to clear up the mess of reorganisation. The small business, enterprise and employment Bill restricts redundancy payments to public officials. If ever there were a Bill that locked the stable door after the horse had bolted, this is surely it. When the Health and Social Care Act 2012 went through the House, there were repeated warnings from Labour Members, including my hon. Friend the Member for Leicester West (Liz Kendall), that the reorganisation would result in primary care trust staff being made redundant and then rehired, with, as a result, a huge waste of NHS resources. In June 2011, the Leader of the Opposition challenged the Prime Minister in this House on precisely that point. The Prime Minister failed to act on the warning. As a result—these are shocking figures; Government Members should listen
	to them—over 4,000 people have subsequently been made redundant and then rehired within the NHS. In the first three years of the reorganisation, there have been over 32,000 exit packages, averaging £43,500, and 2,300 six-figure pay-offs, 330 of which were worth more than £200,000. The total bill is £1.4 billion and counting. What a scandalous waste of NHS resources when people are waiting longer for cancer care.
	We always know when this Government are on the ropes: it is when they furiously try to blame the previous Government. This time, they cite employment contracts, but that excuse will not wash. Given that they were explicitly warned about this when their health Bill was going through the House before the reorganisation took place, people will ask why on earth they did not bring forward the measures on redundancy in this Queen’s Speech before the NHS reorganisation, not after it. It all adds up to mismanagement of the country’s most cherished asset on a spectacular scale.

Alex Cunningham: I would like my right hon. Friend to know about Port Clarence, a very isolated community in my area which lost the nurse it had for four hours a week. People are having to go through a tremendous tangle within the NHS to find out who is responsible. The local doctors cannot commission the service because they provide the nurse, so they have to go to NHS England, yet we cannot get any progress. It is a terrible state of affairs.

Andy Burnham: This is the point. The NHS is still struggling to make sense of the mess that the Government inflicted on it. Just when it needed clarity and leadership, what did it get? It got drift and chaos. That is the problem it is struggling to deal with.
	The redundancy payments did not only cost £1.4 billion; they have also cost the NHS dearly in lost morale. I ask the Secretary of State to imagine how these redundancy payments and six-figure pay-offs look to the staff to whom he has just denied a 1% pay increase—an increase that would have cost a fraction of that £1.4 billion. The truth is that he does not know how they feel because he refused to meet front-line staff protesting about his decision at the NHS Confederation conference. Well, I did meet them, and I can tell him how they feel. They find it truly galling and feel that they have been singled out by the Secretary of State, whose decision seems like a calculated snub. May I suggest that he urgently reconsiders this approach and finds the time to sit down with staff representatives? Right now, a fragile NHS simply cannot afford a further drop in staff morale. The Chancellor promised this increase and the pay review body judged it affordable; the Secretary of State should honour it.
	The truth is that a whole lot more is needed if the NHS is to be put back on track. It finds itself today in a dangerous place. It is facing escalating problems but has a Government who will not talk about them.

Simon Hart: I want to alert the House as to why the right hon. Gentleman has not at any stage mentioned the performance of NHS Wales, which on every measurement but one is underperforming its equivalent in England, and which is run not by a previous Labour Government but a current Labour Government.

Andy Burnham: My shadow responsibilities do not extend to the NHS in Wales, but the Government have spent a year or more running it down. Just a few weeks ago, a Nuffield Trust report said that the picture was more mixed and that there were some areas in which the NHS in Wales was better than the NHS in England and vice versa. The Government need to look at themselves and to be fair to NHS staff, and not constantly repeat the mantra of running down the NHS in Wales and in England.
	It was to prevent the NHS from being in this limbo—this silence—that we have brought this debate to the House. Until the Government face up to some of the problems caused by their reorganisation, the NHS will not be able to move forward. In the remainder of my time, I want to focus on two areas—leadership and competition—where uncertainty urgently needs to be removed.
	First, on leadership, one of the major flaws of the Health and Social Care Act is that it has created confusion on that most fundamental question of all: who is in charge? Ever since the Act was passed, I have been told of continued tension between Ministers and NHS England. Ministers have repeatedly tried to instruct and overrule, ignoring the independence of NHS England for which they legislated. The problem is that thousands of NHS staff are left receiving mixed messages as to who is in charge.
	I want to illustrate that point with reference to the growing crisis in mental health services, which the Secretary of State did not mention once. There are reports of growing problems in accessing mental health care and, in particular, a dangerous shortage of crisis beds. Despite that, NHS England has made a decision on the tariff which will lead to even deeper cuts to mental health care than to the rest of the NHS. This takes the NHS into new territory, because for the first time, as far as I can see, there is a direct contradiction between Department of Health policy and NHS England policy. The Government claim to support parity between mental and physical health, but their NHS policy is actively widening the disparity.
	Therefore, in mental health—a policy of growing importance—we have complete confusion. People still look to Ministers to sort it out, but they have legislated themselves into the position of bystanders, shouting on the sidelines with the rest. The care Minister took to Twitter, no less, to vent his disgust at the “outrageous decision” by NHS England. People up and down the land will see that and say, “You’re the Minister! Don’t just tweet—do something about it!” The fact is that Ministers should have the power to enforce their own policy of parity, but in the interim NHS England should reconsider the decision to inflict cuts on a mental health system that is already in severe distress.
	In the end, the answer to this uncertainty is simple: the Government should be legislating in this Gracious Speech to correct the flaws of the Health and Social Care Act and restore the Secretary of State’s duty to provide a comprehensive universal service. At a stroke, everyone would know where they stand and who is in charge, restoring grip and leadership in the NHS when it faces one of the most uncertain periods in its history.
	The second area about which there is still considerable confusion is that of competition policy. When the Health and Social Care Act was going through, the Government’s mantra was that GPs would decide how best to organise
	care, but that is not what has happened in practice. Section 75 regulations are forcing commissioners to put services out to competitive tender when they do not think it necessary. That is leading to protracted legal disputes and millions spent on competition lawyers.
	The nonsense that the Health and Social Care Act has inflicted on the NHS was plain for all to see last year when the then Competition Commission intervened in the NHS for the first time in its history to prevent collaboration between two NHS hospitals on the grounds that it was “anti-competitive”. What nonsense this is. It was succinctly summed up by the chief executive of the NHS, who said that
	“you’ve got competition lawyers all over the place…We are getting bogged down in a morass of competition law causing significant cost in the system and great frustration for people in the service about making change happen. In which case, to make integration happen, we will need to change the law.”
	That is precisely what this Gracious Speech should have done: change the law to help the NHS get on and make the changes it needs to make and remove the competition policy, which is fragmenting the NHS, not integrating it. That is the challenge the Government have ducked completely. The problem is that if they stay on this path, the NHS will head in the wrong direction. This Government and their Health and Social Care Act have placed the NHS on a fast track to fragmentation and privatisation when the future demands the integration of care.
	The Opposition are clear that the market is not the answer to 21st-century care. The NHS now needs solutions of scale to rise to the increasing challenges that it faces. The NHS needed such leadership in this Queen’s Speech, but it was offered nothing. Instead, this Queen’s Speech leaves it lumbered with a Health and Social Care Act that puts competition before collaboration and the NHS on the wrong path for the future. The NHS urgently needs a Government who want to talk about the issues it faces and to get on with the job of securing its future. Let there therefore be no doubt that the next Labour Queen’s Speech will repeal the 2012 Act and pave the way for the full integration of health and social care.
	I am coming to the end of my speech—I need only a couple more moments—but I will give way to the hon. Member for Vale of Glamorgan (Alun Cairns), as I promised.

Alun Cairns: I appreciate that some light-hearted comments have been made on both sides of the House, but my constituents have to wait longer for treatment, particularly for cancer care, as they do not have access to a cancer drugs fund. Will the right hon. Gentleman use all his influence with the Welsh Heath Minister to get him to look at introducing such a fund so that my constituents have the same access as people in England?

Andy Burnham: That is obviously a matter for the Welsh Government, but let me provide some clarity on the issue of cancer care. In Wales, 92% of people start their cancer care treatment within 62 days, compared with just 86% in England. I ask the Conservative party to think about that, given that it has constantly run down the NHS in the hon. Gentleman’s own country and constituency, and has misrepresented the outstanding job it does to treat patients with cancer.
	We will legislate for an NHS that has the right values back at its heart: collaboration before competition, people before profits. We will ask the NHS to lift standards in social care, working to bring an end to the culture of 15-minute visits. We will make sure that people can access care closer to their homes, giving patients clear rights, such as the right to see a GP within 48 hours. This is a plan to put the NHS back on track, and it shows why a Labour Government cannot come a moment too soon for the NHS.

Several hon. Members: rose—

Eleanor Laing: Order. The House will be aware that a great many colleagues desire to take part in the debate this evening and that time is limited. I am afraid that I therefore have to impose a time limit of eight minutes.

Liam Fox: Perhaps I may allow the House a slightly more bipartisan interlude by concentrating for the moment on a different part of the Gracious Speech, which is the part relating to our country’s national security. I was delighted to see in the Gracious Speech the Government’s commitment to the NATO alliance, which is underpinned by the hosting in Wales of the NATO summit later this year.
	From 4 April 1949, when it came into being, NATO has become the major instrument of stability and security in Europe. It has taken in newly emerging democracies, such as Greece and Spain. It has been extended to countries formerly in the Warsaw pact, creating a far more safe and stable continent. It has embraced countries such as Norway in the far north and Turkey, giving us security in places where we perhaps have greatest strategic vulnerability.
	However, as we approach the summit in Wales, we need to accept that there are big weaknesses inside our major military alliance. To an extent, the political and military roles that we clearly understood during the cold war have dissolved away, and western countries existing in peace and freedom have become fat on the prosperity and security that they have come to take for granted. Only four members of the NATO alliance currently meet the 2% of GDP floor of spending that they undertook to meet when they joined and, as a consequence, the European continent gives a lower priority to defence and is ever more addicted to welfare. As the Prime Minister and Chancellor Merkel have regularly pointed out, we have now reached a situation in which the European Union represents 7% of the global population, 25% of global GDP and 50% of global social spending. That picture is utterly unsustainable. It is a situation in which the pressures of defence have become great.
	Of course, NATO has had recent success in the way it took charge of operations in Afghanistan, what it did in response to the invasion of Kuwait and, perhaps more successfully, what happened in the Balkans. However, not long ago the Libyan conflict showed us how many weaknesses the alliance has. We did not have enough of some key assets—such as intelligence, surveillance and reconnaissance, or air-to-air refuelling—to the extent that we would not have been able to carry out the Libyan campaign without the United States being on board. Such is the current weakness of European NATO.
	We are confronted with a growing threat in the shape of Putin’s Russia, and we have stood by and watched serial bad behaviour from the Putin Government. They cut off gas to Ukraine, in breach of the NATO-Russia treaty, and we did nothing. We saw a cyber-attack on Estonia, and we did nothing. Russia invaded Georgia, parts of which it still occupies, and we did far too little. I am afraid that the signal the House sent after the debate on Syria only gave Putin the understanding that further aggression would not be rewarded with real resistance by the west, and I am afraid that the events we have seen in Ukraine are, at least partly, a result of how such decisions have been interpreted. We must be careful to ensure that our behaviour does not further reinforce that position.
	We have allowed wishful thinking on Russia to replace critical analysis. We have all wanted to see Russia develop as an open, democratic, pluralistic system, but that is not going to happen, at least not under the current regime. The quicker we understand that, the better for the wider security picture. It is a bullying and thuggish regime that is not likely to change. Its modus operandi is clear: it pumps money into regimes or city states—wherever it can—to try to encourage them to be more Russia-friendly. It issues huge numbers of Russian passports to citizens in those places and then claims that it has to defend them.
	The whole debate about the Ukrainian crisis misses one essential point: it is not to do with strategic or even tactical interests; it is a direct challenge to international law. Putin has said that the protection of ethnic Russians—not even Russian citizens—lies not with the states in which they live, or with the laws, constitutions or forms of government of such states, but with an external state, Russia, which can intervene to protect ethnic Russians wherever they may be. If we allow that to stand, there will be no international law, because it will sweep away every norm of international behaviour that has been accepted since world war two.

Geraint Davies: President Obama has made it clear that he is against Britain leaving the European Union or Scotland leaving the UK. What does the right hon. Gentleman think President Putin’s position would be on those issues?

Liam Fox: With all due respect to anybody outside our own borders, what the United Kingdom decides to do is a matter entirely for the United Kingdom, and what Scotland decides to do is a matter for Scotland. Nevertheless, since the hon. Gentleman asked me what I think about President Putin’s view on those issues, I will tell him what I think about Scotland. Any fragmentation would be not only a fragmentation of our country’s defences but a potential weakness inside NATO, and that is unlikely to help or give comfort to anyone other than those who are a potential threat to our national security. The hon. Gentleman raises an important point, in that events that take place inside the United Kingdom may well have resonances that are not naturally considered when decisions are being taken.
	I want briefly to mention another area of national security of which the House must be very cognisant: the changing nature of the threats we face. We have gone from state threats in the cold war to the domestic terror threat we faced from the IRA, and we now face a transnational terrorist threat. That threat has come at a
	time when we have seen a huge growth in the internet, which allows a lot of the enemies of this country to hide. Back in 1995, when President Clinton was President of the United States, there were 130 websites in the world; at the end of 2012, there were 654 million. That is a lot of places for our enemies to hide.
	Our security services need to be able to operate in the same environment as our enemies, and that to me was the essence of the great betrayal of Snowden. We depend on a moral and legal relationship between our employees and the Governments of our allied states to maintain our security, and there were three elements to what Snowden did. The first was his disclosure about the extent of National Security Agency surveillance. Had he done that inside the law it would have been a legitimate debate in a democracy, but to go further and set out the means by which our security forces carry out their business, or even potentially to set out the names of particular operatives, goes well beyond what is acceptable. In my view it goes from legitimate debate into the business of treason.
	We do not have massively overwhelming security apparatus in this country. We spend 0.3% of Government spending on all our agencies put together, which is what we spend on the NHS every six days. We have good, strong oversight of our security services in this country that we should be proud of, but we must be clear when it comes to national security that peace and security are not the natural state of the world. Those things have to be fought for with every generation, and we have a responsibility to fund that appropriately. We can have neither such restricted freedom that we start to become what we claim to oppose, nor go off on a libertarian rant that takes us to a place that leaves us far less secure than we ought to be. If we get that balance right, we will be doing our duty in this House.

Peter Hain: I wish to speak specifically about the pensions tax Bill and the private pensions Bill in the Queen’s Speech. The Government have proposed the biggest reform to pension tax rules in nearly a century. There is no denying that it is popular to give citizens—especially those with small pension pots—the choice to take lump sums that may be more beneficial to them than eking out a living from the small annual payments on which they would otherwise rely. Paying off a mortgage or a loan on retirement by drawing down a lump sum may well be better for such pensioners, but there is real danger in destroying good annuities. That has been going on for a few decades now, and is bequeathing a nightmare that Government policies are nowhere near capable of preventing.
	We have a rapidly ageing population that is dumping a huge additional burden on the young, many of whom are already leaving university with massive debts thanks to this Government’s dysfunctional policies. Now they will be saddled with subsidising through their future taxes older people who are being encouraged to live for today and not protect themselves for tomorrow.
	The closure of defined benefit schemes and the shift towards defined contribution schemes has been an utter catastrophe. Accelerated further by record demographic changes, that shift is a worldwide phenomenon and a
	product of the neo-liberal orthodoxy worshipped by the right hon. Member for North Somerset (Dr Fox), which has gripped Governments from the era of Margaret Thatcher and Ronald Reagan, and which this Government still seem to be in the grip of. In the US, for example, the number of defined benefit schemes halved in under 30 years, while direct contribution schemes tripled. Australia, also worshipping such neo-liberalism, saw an 80% reduction in the number of workers covered by defined benefit schemes from the 1980s.
	That is the background, but there are disadvantages to the new pension freedom. For example, people might decide to spend all their pension savings at the point of retirement, dooming themselves to poverty later in life. Having saved into a pension fund, received tax relief for many years and reached retirement with a pot of money, they might be tempted to blow the lot at once, meaning that they will never have the benefit of the extra income that they would otherwise have had as they got older. If that happens, the tax relief they receive would not fund a pension, and employer contributions that they may have received along the way would end up funding immediate consumption, rather than providing a long-term income. We know that some people will do that; we do not know how many but we hope the number will be relatively low. Pensions expert Ros Altmann suggests that about 7% of people currently say that they would spend it all. In truth, it impossible to predict that accurately.

Geraint Davies: I am sure that my right hon. Friend is a supporter, as I am, of the idea of a British investment bank. Does he think that the Chancellor should have set up tax incentives to encourage people who have liberated their pension pots to reinvest in a British investment bank and create jobs and wealth for the future, instead of it being blown on everyday consumption?

Peter Hain: That is a very good point.
	The new flat-rate state pension, which is cited in mitigation for this new approach to pensions, still means that a lot of people will fall back on the state having spent all their pension savings. Around 20% of pensioners will still be on means-tested benefits even after the new system starts. People might also try to game the system by taking all their pension money and recycling it into a new pension fund, getting more tax free cash and another lot of tax relief. That could mostly benefit those who are reasonably well-off with high incomes in later life, and it could be costly in extra Exchequer spending on tax relief.
	This is mainly a market problem, and it should perhaps have been possible to reform that market without the draconian retreat from annuities proposed by the Government. Would it have been possible to insist that insurers are obliged to treat customers fairly, and ensure they would be liable if they did not carry out suitability checks to identify which type of annuity was best and offer a good rate? Would it have been possible to reform the way annuities work, and allow more freedom but not complete freedom? What protections will be built into the new system to ensure that unsophisticated consumers are not left at the mercy of product providers offering poor product choices, or higher risk products that people simply do not understand and through which they end up losing significant sums? The Financial
	Conduct Authority needs to be on top of that right from the start, but judging by past form can we be confident of that? I have very serious doubts.
	If guidance is delivered by product providers, those providers are liable to entice their customers towards more poor-value products. Experience shows that they will do whatever they can to try to keep customers’ money, or give them poor value and make extra profit. The annuity market has worked poorly for years, with rising profits to insurers and reducing value for customers. How will the Government ensure that the new products developed finally offer good value, and that the charges are fair and terms reasonable?
	The Government are right to legislate to permit collective defined contribution pensions, but I warn Ministers about over-hyping the benefits. In principle, such pensions ought to be better for employers than traditional final salary schemes and better for workers than traditional defined contribution schemes, but in practice they still suffer from market and actuarial risks. Ros Altmann points out that lower earners may subsidise higher earners, and younger members may subsidise older members. The new pension freedoms to take most, if not all, of the pension pot in a lump sum, however attractive and justified that may be to certain people, may also mean that people prefer pure defined contribution schemes that they can access in retirement if they wish. Collective defined contribution schemes, admirable as they may be in principle, usually mean that people cannot just take the cash, which means they may well be less attractive for members.
	My challenge to the Government is this: rather than leaving the private pension system to market providers and their whims, why not build a new system that works? We need a system with longevity that savers will understand and find confidence in—a lack of confidence in this Government’s approach to pensions is something that I imagine savers and I share. While the Chancellor’s right hand further fragments and individualises pensions through these tax proposals, the pension Minister’s left hand makes legal collective direct contribution pensions. Why should any employer move to that collective system when they can see the Treasury going down precisely the opposite route? I doubt whether many will do so.
	The Government are not doing anything like enough to face up to the time bomb of our ageing society and the whole person social care that the shadow Health Secretary eloquently advocated, or anything like enough to face up to the pensions needed to underpin the new life that is rapidly overtaking us, and the whole person care necessary to protect us. The whole Government philosophy of leaving private pensions to the market and saying to citizens, “Effectively, you are on you own” has failed abysmally in the past, just as I believe it will fail abysmally in the future at a terrible cost to all of us—pensioners, taxpayers and the public in general. I urge the Government to look again and come back with proposals that really begin to meet the scale of both the pension challenge and the whole person care challenge that haunts the whole of this country.

Peter Luff: I am sure it would be churlish of me to consider for a second that the speech by the right hon. Member for Neath (Mr Hain) owes anything to his new-found interest in pensions following his decision to retire from this place at the
	next election. I am glad he is following my example, but I am sorry to hear that he will be lost to this place. I have not always agreed with him, but I have always liked and admired him. I am sure he will be missed by this House and by his constituents.
	Last year, I had the honour to propose the Gracious Speech, a task ably performed this year by my hon. Friend the Member for Portsmouth North (Penny Mordaunt). Like me, she got her loudest laugh for a joke about genitalia, which probably says all one needs to know about this place.
	I was tempted to tear up my prepared remarks—they are not on health, but on the health of our democracy—thanks to the rather shockingly partisan speech from the shadow Secretary of State. I will not be tempted down that path, but I will make one point on health. My father-in-law died over Christmas in a national health service hospital. He had spent nine weeks in two different hospitals on five different wards, always receiving outstanding medical care but never that full personal, human and true compassionate care that the Secretary of State spoke about in his opening remarks. I wish him every success in his campaign to drive compassionate care in the NHS, because it desperately needs it.
	I hope it goes without saying that I strongly support the coalition Government and their achievements, so I shall pass over that section of my speech in the interests of the eight-minute limit. I will simply say this: the Queen’s Speech is not the most radical of recent times, but that is not necessarily a criticism. It contains good and worthwhile measures that I applaud warmly. Indeed, I think the desperate search by politicians for novelty, sometimes engendered by the 24-hour media questing sensation, can actually work against genuinely good government.
	I want to set my remarks in the context of 2015, which is not just an election year but an important year for Parliament. It would have been good if the Gracious Speech had made at least passing mention of the fact that in 2015 we will celebrate two important anniversaries: 750 years since the de Montfort Parliament of 1265, and 800 years since the sealing of Magna Carta in 1215. I know that you, Madam Deputy Speaker, have worked very hard with Sir Robert Worcester on the Magna Carta 800th Committee. Magna Carta embodies the principles that have underpinned the emergence of parliamentary democracy and the legal system in the UK and across the world: limiting arbitrary power, curbing the right to levy taxation without consent, holding the Executive to account and affirming the rule of law. De Montfort’s Parliament 50 years later flowed almost inevitably from just those principles.
	I have the privilege to be the Commons Chair of the Speaker’s Advisory Committee on the 2015 anniversary, alongside Lord Bew from the House of Lords. These anniversaries provide a special opportunity for all of us in this place to engage the public in the history and purpose of our democracy. Parliament’s programme for 2015 will increase public understanding of the fact that Parliament’s work really matters to them, raising awareness of Parliament at work on a local level, particularly with young people. I hope hon. Members will participate in an initiative we are launching with individual schools in our constituencies later this year.
	The celebration of and debate on Magna Carta and our emerging Parliament should serve to remind us of perhaps neglected fundamentals. Democracy is not just
	about voting once every four or five years for a local council, Parliament or the European Parliament. The first condition of democracy is the establishment of freedoms and rights in a society that can be upheld independently of the ruler or ruling elite. Voting comes next. That leads me to my three main concerns about the Queen’s Speech: the consequences for defence, liberty and the local experience of democracy.
	On safety overseas, the Queen’s Speech said surprisingly little. My right hon. Friend the Member for North Somerset (Dr Fox) made a powerful speech, saying many of the things I wished to say. In the year in which British troops end their combat mission in Afghanistan, we might have hoped for more on defence in the Gracious Speech. The UK has committed to spend 0.7% of GDP on international development. I welcome that, but why do the Government, who already spend more than 2% of GDP on defence in accordance with NATO guidelines, seem so reluctant to commit formally to this target? Why do they not do more to engage our European colleagues in meeting that target too? Why did the Queen’s Speech not say something about the preparatory work for the next strategic defence and security review? We need a debate on Britain’s place in the world, a debate that would inform the Scottish independence referendum and our relationship with the EU. An open debate ahead of the SDSR would be invaluable, and it would have been good to see a commitment to that in the Queen’s Speech.
	On liberty, the Bill to strengthen the powers to prevent modern slavery and human trafficking is an excellent one to enact in the year of Magna Carta’s 800th anniversary. The work of the Gangmasters Licensing Authority has made a major contribution in my constituency to reducing the exploitation of those working in the farming and horticultural sectors, but much more remains to be done. I am proud to support a Government who are putting such an enlightened and important piece of legislation on the statute book. When we think of personal liberties, we should recall that of all Magna Carta’s many clauses only four remain on the statute book today. Two of those, clauses 39 and 40, are about no freeman being imprisoned except by the lawful judgment of his peers, and no one being denied justice.
	I welcome the action on modern slavery, but I must sound a loud warning note on legal aid, for which further changes are planned in this Session, including secondary legislation on Crown court advocacy fees. We must recognise that access to justice is not just a Magna Carta right, but a fundamental part of our democracy. We cannot lecture authoritarian states on their lack of democracy if our own system is denying ancient rights to our citizens. If the state proceeds against an individual unreasonably, as has manifestly happened on several occasions recently, the individual should have the proper means to defend himself or herself against those proceedings. The legal aid bill is tiny: at £2 billion, it is just one-twelfth of the £24 billion housing benefit bill. In other words, an 8% saving in housing benefit would pay for the whole legal aid bill. This Parliament should be profoundly concerned that injustice will grow and families will suffer if deep cuts to legal aid are made. In the run-up to the commemoration of Magna Carta, we should be especially heedful of such things.
	My final remarks perhaps reflect my deepest concern about democracy in our country. I end with one measure of direct relevance to my constituents and their sense of justice and fair play and the upholding of their democratic rights: the planning system. This one issue has done more to disillusion many of my constituents about the reality of local democracy than any other I am aware of. I agree we need to build more houses both nationally and locally. The three councils of south Worcestershire—Wychavon, Malvern Hills and Worcester City—agree with that view with passionate conviction, but I worry about exactly what is meant by the commitment in the Queen’s Speech to increase housing supply and home ownership by reforming the planning system.
	A packed meeting at Badsey Remembrance hall on Friday was powerful evidence of the sense of betrayal that people in many parts of England feel about the collapse of local planning policies. Indeed, I believe my party has lost more voters to UKIP over this breakdown in planning than over the EU. At Friday’s meeting, attended by parish councils and residents from across the Vale of Evesham and throughout Wychavon, I told the audience about what was being done and our great success in building houses—some three times the national average in my constituency—in south Worcestershire. Our area is pulling its weight. We want to build houses in the quantities needed, but where local people believe they should be built and not where developers decide. It is the developers who have the whip hand in my constituency. Through no fault of my council, we are being punished for not having a local plan in place. The only reason we are late is that the Government failed to abolish the old top-down system of regional spatial strategies in good time. We followed Government policy, but we are being punished for doing so.
	Wychavon district council wants to do the right thing and build the new homes that we need, but still the Planning Inspectorate makes it clear that it expects even more. The result is a demoralised district council and angry communities. All the inspectorate needs to do is say that planning permissions already granted will count against our target and commit to ensuring that our new local plan can be the test of new applications from developers now, not when it finally comes into effect.
	At Badsey on Friday night I was given a bag of Vale of Evesham soil. The person who gave it to me wanted it to remind me of the valuable horticultural land being lost to unplanned development. It reminds me of much, much more: it is the soil of the county where the founder of our parliamentary democracy, Simon de Montfort, died. It stands for the liberty of the people. It is our sacred duty in this place to protect it.

Ann Clwyd: This is the seventh occasion I have quoted from patients’ letters on the NHS. They are patients from all over the country. In some cases I will name where they come from, because they have given me their permission to do so.
	A few weeks ago, when I gave evidence to the Select Committee on Health, I was asked whether things had changed as a result of the report I produced jointly with Professor Tricia Hart last year. The only way I could answer was to say that I will know that things have changed when the letters stop. I am afraid the letters have not stopped: they keep coming, and while they keep coming I shall continue to quote from them.
	I received a letter from a woman who went to see a friend in hospital. The friend was given an enema while she was there. The letter states:
	“Myself and other visitors therefore waited outside while this took place. The nurse then disappeared for forty minutes. When I questioned the nurse about being away for so long she explained that there are two other staff members on the ward but they are not qualified to carry out this procedure…I then waited outside again while she was changed. Once this was finished I noticed that her nightgown had not been changed, so therefore assumed it was clean. The next morning when I arrived with a clean nightgown, she was still in the previous day’s clothing and was not changed until she had been washed. Later, when I was going home, I found the previous nightgown shoved into a cupboard in a plastic carrier bag. The nightgown was completely soiled, so it was evident that she had been left wearing this from roughly 2pm and throughout the night. I reported this to a nurse who said she could not explain why this had happened.”
	This illustrates again the importance of patients in hospital being shown dignity.
	Another letter concerns a wife visiting her husband in hospital:
	“The oxygen mask he had on had slipped down off his nose so many times it had blistered it, his wife had to put plasters from the pharmacy on herself. On his bed table at the foot of his bed was a pack of sandwiches, bottle of fizzy drink, a urine tray with urine in it and standing in that was a urine bottle half filled with urine…The man 2 beds up soiled his bed, stripped naked and walked round the ward with excrement all up his legs. Out of the ladies toilets came a lady crawling on her hands and knees with her underwear round her ankles, 2…nurses picked her up, said she was a naughty girl and dragged her up the ward. Then 5 minutes later out of the other door first appeared a walking stick, then a little man wearing a nightgown and a hat with a bobble on the top, stick in one hand and dragging his soiled nappy full of excrement behind him past”
	her husband’s bed.
	Another letter said:
	“I have been waiting for over three months for a colonoscopy at Singleton hospital, Swansea. I have pains in my stomach. I attach an e-mail received from the Health Board stating that the waiting list for urgent endoscopies in Swansea is 35-40 weeks. No estimate is given for non-urgent endoscopies. I find the situation scandalous. If you wish to publicise this appalling state of affairs and use my name, you can do so.”
	The health board wrote to the man saying:
	“Unfortunately, the Endoscopy department is experiencing a backlog of patients waiting for appointments, due to the ongoing demands on the service. The current waiting time in Swansea for an urgent endoscopy can be up to 35 to 40 weeks. Plans are in place to address the backlog over the coming months. In the meantime if you are experiencing symptoms which you are concerned about, they would suggest you make an appointment to see your General Practitioner”.
	Another letter states:
	“My mother aged 85 was admitted to hospital…and treated as an in-patient for 3 weeks for a badly sprained wrist. My concerns about the longevity of the injury and lack of improvement, continued pain and swelling were ignored and only after an official complaint was made…by me did medical staff agree to re x-ray the wrist, where upon it was found to be badly broken. Whilst still an in-patient…when her wrist was due to be set, my mother’s call for assistance to help her to the bathroom went unanswered and she fell in the ward. I was not contacted by the hospital and advised of her fall. When I made it known to staff that I knew she had fallen I was told ‘it was nothing, a little fall and there was no injury’. My mother was discharged…I had to call out her GP”
	a couple of days later
	“since she was experiencing severe groin pain. Over the weekend the intensity of pain increased and my mother could no longer walk. She was taken by ambulance to Morriston Hospital, an
	x ray revealed a fracture of the pubis and my mother was again admitted as an inpatient that evening.”
	She then talks about the standards of medical attention, stating that the
	“care received was negligent, her treatment was inappropriate and exacerbated her injury. The consequence for my mother is long term and permanent impairment of mobility and quality of life.”
	Another letter concerns someone admitted to a hospital in north Wales:
	“Doctors were rarely seen especially not at weekends, equipment had to begged and borrowed from other wards. I feel that when he was admitted he was seen as a very old man who was probably not going to survive…He’d always been a positive, uncomplaining sort of person. It was subsequently discovered that he had an ulcerated digestive tract so forcing him to eat, as was initially happening, was bordering on the cruel.”
	Finally, a letter states:
	“I went to the GP last February and was diagnosed with a prolapsed womb. I was put on the proverbial waiting list. After two months I rang the Princess of Wales hospital to ask how long to my appointment. I was told the earliest I would be seen would be end of August possibly early September! A few weeks ago against all my labour principles and out of sheer anxiety of the unknown I paid £150 to see a gynae consultant (this was in one week of phoning for an appointment!) The consultant confirmed I had a prolapse, I would need a hysterectomy and a bladder repair…I was then told if I paid privately I could have the operation in two weeks!”
	at a cost of £6,646. The letter continued:
	“However this is the punch line. If I wanted to be put on the NHS list it would be 9/10 months! That means from seeing my GP to surgery will be 18 months. I can not believe it! I refuse to go privately; I want NHS treatment. My condition is now impacting on my everyday life…without going in to the finer details it is undignified. I went back to my GP last week asking her to expedite my referral.”
	That is one of many shocking cases, and I could fill the next five hours reading out the others I have received.

Richard Benyon: It is a great pleasure, but a daunting prospect, to follow the right hon. Member for Cynon Valley (Ann Clwyd), who is a model of dignity for the House and has shared some truly horrific experiences with us. I want to talk mainly about public health, but before I do so, I should like to raise an issue that is not unrelated to what the right hon. Lady has mentioned.
	I have been fascinated by the fact that the Mid-Staffs issue has not resonated as a major concern with the vast majority of people in this country. Perhaps I missed it; perhaps it is there just under the radar. To me, it should be seared on our collective conscience as a nation. If 1,200 had wrongfully died, say, in police custody or in some other area of direct Government responsibility, there would be crowds of people out on the streets. Yet this was a collective failure and a national failure. Irrespective of what has been said in certain journals by certain Members, this was not a local issue, but a national one in which neglect, incompetence and something called cognitive dissonance was allowed to fester—and people died in large numbers.
	We rightly revere the NHS. As with my hon. Friend the Member for Mid Worcestershire (Sir Peter Luff), I have had recent experience of a close relative being treated in the NHS, and I have nothing but praise for the staff who treated him. Where there is failure, and when people are treated in the sort of way mentioned by
	the right hon. Lady and dignity and care fall by the wayside, we have to act. I believe that the implementation of the Francis report is a major step on that road. I applaud the Secretary of State for his determined approach to put patients first, by putting in place measures, individuals and safeguards so that Mid-Staffs does not happen again.
	As I said, I want to talk about public health, which I believe is so important to how we are going to be able in the long run to afford a national health service. So much of that is about diverting people away from needing it. It is also about addressing inequalities. I have worked hard with other Members to make sure, for example, that rural areas are not left aside. When I was the Minister with responsibility for rural affairs, my hon. Friend the Member for Beverley and Holderness (Mr Stuart) raised the issue of stroke treatments in his constituency. It is, of course, much quicker and easier for a stroke therapy consultant to spend all their time in Hull, dealing with many more cases in one day, rather than getting out into the rural areas. Addressing those health inequalities is now, however, for the first time a statutory requirement. That is a major step forward. It does not just involve national bodies such as NHS England and Public Health England; local care commissioning groups and local authorities are ensuring that inequalities are addressed.

Kevan Jones: I agree with the hon. Gentleman that there is a specific need in rural communities. Does he support the Government’s action in taking need out of the assessment for public health funding, which has meant that areas such as mine in the north-east have lost funds that have been redistributed to wealthier areas in the south?

Richard Benyon: I do not know what happens in the hon. Gentleman’s part of the north-east, but I can tell him that there is now a real drive to deal with the problems in the constituency of my hon. Friend the Member for Beverley and Holderness. My hon. Friend felt that his constituents were getting a raw deal under the old system, and there is now a statutory requirement for that to be addressed.
	The new responsibility for public health means a great deal to us as constituency Members. The West Berkshire health and wellbeing board, ably led by Councillor Marcus Franks, is taking the initiative locally, not just dealing with massively important issues such as reducing smoking but encouraging, through a partnership approach, lateral thinking and the tackling of disease and illness before they happen. We must ensure that that happens at local level as a result of legislation that has been introduced in the past.
	I was pleased to be one of the authors of the natural environment White Paper. We worked closely with the Department of Health, with the aim of helping people to understand the healing benefits of nature and the great outdoors. Initiatives such as Walking for Health have created a virtuous circle. Improved health has led to greater companionship and less isolation, and organisations such the University of the Third Age have improved the quality of life for lonely and, in some cases, elderly people—and, of course, there is the additional
	benefit of a lower health care bill for the taxpayer. All that is crucial to our objective of diverting people from health services.
	About 20 years ago, a health service manager said to me, “The trouble is—from my point of view—that clever people keep inventing expensive new cures which we have to fund. People survive longer as a result, and that means yet more costs, because they will need the NHS at a later stage.” I think that he was being light-hearted, but it was probably just a half-joke. His point was this: if we, as a society, are to be able to afford the NHS that we want in the future, whichever party is in government, we must continue to divert people from it by keeping them healthier. The lateral thinking to which I referred earlier has never been more important.
	I applaud the housing association that, working with its local health and wellbeing board, identified a large number of elderly people who were being admitted to hospital following accidents in the home. Simply employing a handyman to do some work in their sheltered accommodation resulted in a reduction in the number of injuries, particularly serious injuries such as broken hips, from which many people do not recover.
	Another initiative in my area is “brushing for health”. Good oral health is vital, and my local health and wellbeing board has launched a programme involving Sure Start and other children’s centres, encouraging children to adopt diets that are lower in sugar and to brush their teeth more regularly, and ensuring that they will have access to a dentist. Promoting that initiative will mean that less national health dentistry will be required in the future.
	On Saturday, I was delighted to launch the Newbury dementia action alliance. We know that 800,000 people in this country are living with dementia, and that it is costing the country £23 billion a year. It is great to hear that the G7 world leaders are getting together and making dealing with dementia one of their priorities, but what does that mean in our constituencies? It means, at local level, stimulating the minds of dementia sufferers, supporting their carers, ensuring that healthy living is part of the norm and involving organisations such as the fire service and the police.
	That was a very quick canter around the importance of public health. I am running out of time, but let me end by saying that when we talk about health, we must not just talk about the important factors that surround the core of the national health service. We need to prevent people from becoming ill in the first place, and that is why the Government’s concentration on public health is so welcome. There is, of course, much more to be done, but a very important change has been made.

Nick Brown: It is a pleasure to follow the hon. Member for Newbury (Richard Benyon). Let me begin where he left off. For the past two years, along with other Members of Parliament representing the north-east and Cumbria, I have been arguing against attempts to alter the health service’s funding formula and reallocate funding, taking it away from deprived areas with poorer health outcomes and giving it to more affluent areas with better health outcomes. Last year, the Government’s original proposals would have led to a reduction of £230 million in the annual health funding of the north-east and Cumbria.
	NHS England eventually opted for inflation-proofed increases for all clinical commissioning group areas, along with extra increases for some favoured clinical commissioning groups in more affluent parts of the country. I should welcome an assurance from the Minister that we will not have to go through that fight again.
	The Government’s top-down reorganisation of the national health service is riddled with gaps and negative consequences. It has significantly increased pressures on A and E departments, which have now become the default places to visit if people need to see a doctor within days. It is no longer possible to make an appointment with a GP a day or so in advance, and many people have to wait several weeks for an appointment. There are arbitrary, cost-influenced restrictions on procedures and treatments, leading to a postcode lottery whereby some services are free in certain parts of the country but not in others.
	Clinical commissioning groups are reported to have spent more than £5 million on competition lawyers to try to navigate competition law in relation to commissioning services. More than £1.4 billion has been spent on redundancies in the NHS, only for thousands of people to be re-hired under the new structures. I understand the latest figure is over 4,000. That point was made forcefully by my right hon. Friend the Member for Leigh (Andy Burnham) in his opening speech, and I support every word that he said.
	There has to be an answer to this, and it is not coming from the Government. Health Ministers are increasingly hiding behind NHS England when it comes to big policy questions relating to the NHS, and more and more answers to parliamentary questions are being referred away from the Department and to unelected, largely unaccountable bodies. There is also the overarching issue of GPs’ now having key functions as commissioners, as well as functions as providers of services that are being commissioned. The obvious conflict of interest is corrosive to the ethical underpinning of the NHS.
	I have the honour to represent the Freeman hospital and its internationally renowned heart units, including its high-achieving children’s heart unit. In the 2001 review of the Bristol children’s heart unit, Professor Sir Ian Kennedy clearly stated that England needed a smaller number of centres of excellence to undertake the complex, highly skilled procedures involved. No one has refuted his arguments, but, 13 years later, we are no closer to achieving the outcome that he said was desirable.
	We cannot, and should not, let that issue drift. The Government have an obligation to set out a clear way forward that is compatible with Sir Ian’s recommendations, and to do so on the merits of the medical arguments and not on the basis of political expediency. The delays in addressing the issue over the four years of the current Parliament pose the risk that it will extend beyond the next general election, yet we are no clearer about the future of children’s heart units in England. Again, a response from the Minister on the issue would be welcome.
	I want to raise the recommendations of the NHS Pay Review Body and the blocking of the recommendations by the Government. That decision comes after a two-year pay freeze and significant pay restraint following the two-year period. When factored against inflationary pressures, nurses’ pay has fallen by 10% in real terms over the past four years. Alongside that, contributions to the pension arrangements have increased, coming out of take-home pay.
	The Government should not treat individual increments as if they were pay rises. Forty-five per cent. of nurses do not receive an increment. The Government should not set the NHS Pay Review Body recommendations to one side. They are wrong to insist instead on an offer of a 1% non-consolidated payment for this year, followed by a 2% non-consolidated payment for the following year. If nothing else happened at the end of this period, the nurses would be substantially worse off than they are today. These are pressing issues for the national health service.
	I should like to make a more general point about the Queen’s Speech’s failure to touch on the most significant problem facing the north-east of England. Unemployment in the region remains the highest in the country, at 10.1%. Despite recent national falls in unemployment, it remains stubbornly high in the north-east.
	The unemployment rate for the region has actually increased in 2014. There is a continued need to create sustainable well-paid jobs through private sector economic development in the region. The tragedy is that the parties do not quarrel about this: we agree on what needs to be done. The issue is doing it. Youth unemployment remains high and more needs to be done to open up opportunities to work and training.
	Four years ago, the Government made sweeping changes to the delivery of economic development in the English regions. The Government’s reorganisation is not working for the north-east of England. Apart from the projects that were already under way under the last Labour Government, the present arrangements have little to show. Governments often make their largest mistakes in their first 100 days. Having abolished the regional development agency and Business Link, the Government have spent the last four years trying to set up structures that will carry out the functions that those bodies used to undertake, and in our region the efforts so far have achieved very little. This matters because it is our region’s core problem.
	The Government’s original idea was that the new localism contained the answer to the north-east’s economic development questions. The coalition Government argued that the setting up of new locally based bodies would be the right way to provide economic development at local level. Over the past four years, the means has become the end. All energies have been focused on those structural questions. The purpose for which they were originally intended has almost been completely lost sight of. A single Minister needs to get a grip of these arrangements, which now span a range of different Departments, and force them to focus on specific economic development initiatives.
	These are important issues. Now that the House has committed itself to fixed-term, five-year Parliaments, it is likely that all future final sessions will have something of the character of this one. There is something unsatisfactory about it all. I feel that some of the big questions and the attendant debate are slipping away from Parliament.

Priti Patel: It is a pleasure to speak in the debate because it is a Queen’s Speech that will help to deliver a stronger economy for this country and better and stronger public services. Four years ago, this
	Government embarked on a radical and necessary programme of measures to turn the fortunes of this country and our economy around. For 13 years, my constituents were betrayed and let down by the previous Government, as taxes rose while unemployment soared, the economy went into meltdown and public services wasted taxpayers’ money on a colossal scale.
	It is a tribute to this Government’s economic focus and policies that we have been able to turn things around. Ministers have implemented many clear measures. For example, unemployment in my constituency is now almost half the level it was when it peaked under the previous Government in 2009. These are the positive policies that I bring to today’s debate on the NHS. It is a testament to this Government’s commitment to the NHS that we are now seeing an increase in spending.
	I heard the opening speeches in the debate, including by Labour Members. It is appalling that the Labour party likes to talk as though it owns the NHS politically. That is wrong. Labour should listen to some of the facts not just in my constituency but in the eastern region. The fact is that Labour went into the last general election with plans to cut NHS spending—we have heard about the impact of that in Wales—while we have continued to invest in the NHS. While Conservatives recognise the increasing pressures that the country faces from demographics and the health care needs of the public—

Lyn Brown: Will the hon. Lady give way?

Priti Patel: I want to develop my discussion and go into more detail on the NHS. More investment in the NHS is required. This is not about cutting services, including front-line services, or funds. It is about expanding the NHS in the right way and, as the Secretary of State said, putting patients first and moving away from the bureaucratisation of the NHS.

Lyn Brown: Will the hon. Lady give way?

Priti Patel: Let me continue.
	There were classic examples of that not just in my constituency but more widely in Essex. We heard earlier about Basildon hospital. In my constituency, one primary care trust saw its number of managers and senior managers increase tenfold over a decade. At the same time, it failed miserably to recognise the health needs of my constituents; we have a growing population as well as an ageing population. I had cases in 2010 where patients were denied access to life-saving hospital treatment and access to drugs because the PCT sought to prioritise spending on the bureaucracy of the NHS, rather than front-line patient care.
	In Witham town, at the heart of my constituency, there is a chronic shortage of locally accessible health care facilities. All the talk by Labour and the slogans referring to “record investment” under Labour translated into nothing in my constituency. Under the previous PCT and the previous regime, we had consultation after consultation but no new services were created.

Lyn Brown: Will the hon. Lady give way?

Priti Patel: Just a second. Our GPs are among the most highly subscribed in the country, with 2,200 patients per GP compared to the national average of 1,500—that is over 40% more patients per GP than average. Not only did Labour fail to plan, but the former PCTs have left a chilling legacy of debt and financial mismanagement, which has held back our new clinical commissioning group from providing innovative solutions and new local health care.
	I thank NHS England, the Department of Health and the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). They have been incredibly accommodating and are looking to create local solutions and to expand front-line services in Witham town. We have been looking at bringing in a new, purpose-built medical centre in the town, which would provide new and integrated primary care services and make services more accessible for local people. Such a centre could even go as far as integrating our local ambulance services, too, in order to bring greater collaboration and integration across our local NHS, which is needed.
	These provisions do not need to be included in legislation. This is not about new legislation in the Queen’s Speech. This is about a commitment at the grass roots from health providers and GPs to get on and start delivering these services. We did not have that commitment before.
	Another example of where we were completely neglected is the East of England Ambulance Service. It is a fact that we have had endless problems. That was down to a culture of mismanagement. Front Benchers will be familiar with the crisis that we had in our ambulance trust. We had great paramedics who were doing a very difficult job, but they were being let down by hospitals, A and E, and the target culture. The service was worse than poor; it was inadequate. The trust is now recovering, thanks to Dr Anthony Marsh. Last Thursday night, I joined the ambulance trust and its team from Witham ambulance station on patrol and I cannot praise them enough for the work they do. It was interesting to see the handover in patient care as we turned up at Broomfield hospital and Colchester general hospital. We need greater integration so that we are putting patients first in the provision of front-line services.
	Colchester hospital has been held back because of the legacy of the culture of targets. Because of the problems we had with East of England Ambulance Service, Colchester hospital had a target-driven culture that led to horrific examples of falling standards of care and data being manipulated. Investigations are taking place now. While what has happened at Colchester is nowhere near as damaging as what we have seen at other hospitals such as Mid Staffordshire, it shows what happens when targets overtake the delivery of quality front-line patient care. This should not be about bureaucracy, inputs or targets. We need an integrated approach so we deliver effective front-line patient care.
	We struggled in the eastern region, and in Essex in particular, with the NHS legacy of the previous Government. It has been a real challenge for all health care professionals—I have mentioned our hospitals and the ambulance trust—and these are individuals who are dedicated to serving patients and doing the right thing, but they have been held back. The innovations and the NHS reforms, as well as the new investment being provided, will help to secure new services for my constituents and a more patient-friendly approach in Witham town.

Siobhain McDonagh: Today I would like to add my voice to those of all who have expressed disappointment and surprise that the Queen’s Speech contained not one word about the NHS. Last month’s local elections in Mitcham and Morden, and in large parts of London, were dominated by the issue of health. The verdict was overwhelming: overnight, Merton went from no overall control to Labour control, with the people of Mitcham and Morden electing 30 Labour councillors out of 30 for the first time in history. In large parts of Merton one issue stood out: the future of my local general hospital, St Helier. Anyone driving through Morden will see hundreds of signs in front gardens and windows—yellow signs with a red heart in the middle, all saying “Save St Helier.”
	The Government should have used the Queen’s Speech to listen to the people. Labour would introduce an NHS Bill; the Government included not a word about the NHS. During the local election campaign, Merton’s Conservatives said that, no ifs, no buts, St Helier was safe. Their leader proclaimed that
	“St Helier Hospital has been saved”,
	but St Helier has been under attack for years under this Government. In 2011, the local NHS said the Government had told it to
	“deliver £370 million savings each year...around 24% in their costs.”
	A new body called Better Services Better Value was set up. It announced it would close A and E and maternity units across south-west London and Surrey, and St Helier would also lose its intensive care unit, paediatric centre, renal unit and 390 in-patient beds. A save St Helier campaign was launched, and the petition has now been signed by more than 13,000 of my constituents. Three local campaigners—Sally Kenny, Stan Anderson and Mary Curtin—decided the issue was so important that they should stand in the local elections in Lower Morden as residents whose primary aim was to save St Helier. Given the backing they had from Councillor Stephen Alambritis, the Labour leader of Merton council, they stood for Labour. Just before the election, doctors in Surrey, where Epsom hospital was also threatened, vetoed the plans. BSBV was wound down in ignominy. It seemed we had won a reprieve, but when the huge banner covering the front of St Helier hospital that said
	“Coming soon—We’re spending £219m on a major development”
	was taken down, residents realised that victory was only temporary.
	The best any of us could hope for was a few years’ peace and quiet. As it happened, the reprieve lasted until only five days after the election, when the local NHS published a new five-year plan that it says will
	“change the way we deliver health services”.
	Far from listening to the people, who voted in unprecedented numbers to save St Helier, it ignored the verdict of the people. The plan describes the
	“likely need to reconfigure maternity and neonatal services”.
	Of course, “reconfigure” is just a euphemism for closures, and it suggests that A and E units will be downgraded by 2018, with what it describes as the introduction of two levels of emergency departments—major emergency centres and emergency centres. The plans do not say
	which maternity units will be “reconfigured” or which A and Es will be downgraded to emergency centres, rather than full-blown A and Es, but, after years at risk, nobody thinks St Helier’s future is secure.
	The leader of Merton council, who won an overwhelming mandate just weeks ago, is so angry that he has told the chair of Merton’s clinical commissioning group, who has headed the local NHS throughout BSBV, that the people had spoken and his job was no longer tenable. Councillor Alambritis said:
	“BSBV has been a fiasco and the voters of Merton delivered a devastating verdict...Ultimately, responsibility lies with the Chair, and he has to go…Merton’s residents have demanded change, and the Chair needs to respond to that”—
	and so should the Government. They have spent the last four years undermining, rather than strengthening, our NHS.
	In 2010, the Conservative party manifesto said it would stop the centrally dictated
	“closure of A&E and maternity wards, so that people have better access to local services, and give mothers real choice over where to have their baby”.
	The people of Merton remembered that quote, and it is no wonder they voted the way they did a fortnight ago.
	This is a democracy. The Government should respect the ballot box. My constituents do not want a Queen’s Speech that has not got a single word to say about the NHS. They want a Queen’s Speech to save St Helier, and save our NHS.

Jackie Doyle-Price: I have reflected on the comments of the hon. Member for Mitcham and Morden (Siobhain McDonagh) and I really must tackle head-on the belief that because there is no Bill on the NHS, that is a weakness. The reality is that the NHS does not need more legislation. What it needs is good leadership and good performance management so that it delivers what we want it to deliver for our constituents. We will not improve the care of patients by sitting on these Benches and pontificating and giving the benefit of our experience. What we need to do is empower real practitioners to actually deliver change.

Siobhain McDonagh: May I inform the hon. Lady that many of my constituents in Mitcham and Morden believe the withdrawal of clause 119 from the Care Bill would have done a lot for their NHS?

Jackie Doyle-Price: I cannot agree with the hon. Lady. The important thing is that Government Members make it clear to the NHS that we expect it to put the interests of patients at its heart. I want again to draw attention to what has happened in Basildon and Thurrock university hospitals trust because it is perhaps the best example of the profound change we have had in NHS culture over the last five years. We now have a Government, and leaders within the NHS, who are finally prepared to face up to what is going wrong and to deal with it, rather than to cover up, be complacent and say, “We’re no worse than anyone else.”
	I have to say that it has been a turbulent journey for those of us involved in Basildon hospital over those five years. The shadow Health Secretary, who is not in his place, will recall coming to this House in 2009, at the
	same time as he spoke about Mid Staffordshire, to highlight exactly what was going wrong at Basildon. Since then I have had a number of conversations with senior managers in which I was told, “Well, we’re no worse than anyone else. You’ll find this everywhere.” That was not good enough, but after two and a half years of not making any progress at all, Members of this House had very robust discussions with Monitor and said, “This needs proper intervention.” That led to a complete change in the leadership. A new board was appointed that was more inclined to give challenge where it was due. We had a leadership team that put stronger emphasis on good clinical leadership, and a chief executive was appointed who was determined to make sure that Basildon hospital delivered the standards of care that all patients deserve. What we have had is cultural change, and cultural change comes from leadership; it does not come from legislation. As I have said in many contexts, any organisation is a creature of the person at its top, so when we get good leadership in individual hospitals we get a step change in performance.
	I also wish to pay tribute to the Secretary of State for the continued emphasis he places on patients, because when the head of the NHS—the person operationally responsible here in Parliament for performance—is articulating that, it will spread the cultural change which will deliver the real change in performance. I pay tribute to Clare Panniker, Basildon hospital’s current chief executive, who has delivered this significant change in the 18 months she has been in post. She has taken Basildon from being one of the worst performing hospitals to a position where it is coming out of special measures. She has been ably supported by the chairman of the trust, who has also been prepared to give a robust challenge and to stand behind her when she was doing so. Most of all, I wish to pay tribute to all the staff at Basildon. It has not been easy for them—it has not been good for their morale to see in the newspapers regular reports of the latest horror story of poor care within the trust—but they have reacted to the cultural change that Clare Panniker has brought. They have bought into it and given good, honest feedback, and I no longer get whistleblowing letters from staff about the latest incident. They have procedures to act on things and the management then implement that change. It says a lot about the commitment of the staff in that hospital that they have bought into that process and delivered us to where we are now. We all need to learn that sunlight is indeed the best disinfectant. It is not good enough to pretend that there is not a problem when there so clearly is, and it is important that we continue to put patients at the heart of the NHS. Only by doing that will be able to ensure that the incidents witnessed at Mid Staffs and Basildon will become a thing of the past.
	I wish to turn my attention to another issue that was not mentioned in the Queen’s Speech but which is on the Government’s legislative timetable for the coming year: the plan to introduce standardised packaging for tobacco products. I have to say to the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb) that it is a very bad idea. I fully support the policy objectives of tackling tobacco consumption and, in particular, of dissuading and preventing children from ever taking up smoking,
	but I have worries that this tool is not effective and that its unintended consequences may bring about worse health outcomes than doing nothing at all. Sir Cyril Chantler is said to have examined that as part of his review, but I am not persuaded of the evidence. In particular, I believe that introducing standardised packaging will worsen the public health outcomes if unregulated illicit tobacco products replace the regulated ones. We all know how toxic regulated cigarettes are, but when unregulated products enter the market the health outcomes will be very much worse.
	Sir Cyril Chantler has concluded that Her Majesty’s Revenue and Customs has been very effective in tackling contraband and illicit tobacco, and he has cited figures going back to 2001. Although they show an improvement, the nature of the problem has changed over that period. European Union enlargement took place during that time and there was an immediate rise in the amount of illicit tobacco, but that has been tackled, mainly through co-operation with tobacco manufacturers. That illicit tobacco was also a legal product, whereas the illicit tobacco coming into this country today is not from Europe and it is not from regulated markets; it tends to be made in places such as China and Indonesia. Some of these products are extremely nasty, with tobacco rolled with whatever is available and containing high levels of tar. I commend The Sun for the exposé it ran last week in which an illicit producer from Indonesia explained just how toxic some of his products are and how standardised packaging will help him make money by reducing the costs of production.

Alex Cunningham: The Government’s own inquiry showed that there would not be an increase in the amount of illicit tobacco traded in this country. Does the hon. Lady not trust her own Ministers and the report they commissioned?

Jackie Doyle-Price: I was quoting that report and challenging its conclusions, which are based on a flawed analysis of the market—that is what I have been trying to explain. No, I do not trust that report. It is superficial and it has been put together with a particular agenda. As I say, it will lead to unintended consequences which will be very bad for public health.
	My constituency contains Tilbury docks and the Purfleet ferry terminal. Despite the best efforts of Border Force, Essex police and the port of Tilbury, these products are getting through. Despite large seizures every week, Border Force does not believe that it is getting even 10% of the illicit product that is coming into the marketplace. It is estimated that one in three cigarettes smoked in London are illicit, and a good proportion of them will come through the ports in my constituency. Standardised packs will inevitably reduce costs for illicit manufacturers, who will be able to produce the product without differentiation in brand. I believe this proposal is a charter for a lot of very nasty people to make a lot of money, and if they do, the health outcomes we wish to see will not be achieved.
	Let us be frank: we are talking about packets of cigarettes sold from holdalls behind pubs for a couple of pounds. Children do not start smoking by walking into their newsagents and picking a branded product; they are introduced to smoking via that holdall, at the back of the bike sheds or at the back of pubs. When
	cigarettes become that cheap, because of the proliferation of illicit products in the market, these children will be smoking some very nasty things. I ask Ministers to think again, because this is not the best tool for achieving a reduction in smoking and there will be unintended consequences for public health. I ask this Minister to sit down with Border Force and understand just how difficult the fight is that it is waging against serious organised crime and smuggling.

Ronnie Campbell: Interestingly, health is not even covered in the Queen’s Speech, but we are debating it so I will say a few words about it. The good news is that my granddaughter has just been accepted by Liverpool university to study midwifery, so that is some compassion coming back into the health service. The bad news is that on Friday I had a meeting with GP commissioners who came to see me because they are teetering on the edge. I am talking about the Northumberland commissioners who are running the doctors consortium. They had a budget, worked to it and were doing all right until the Government came along and clawed money back. I would not mind if the Minister tried to say why the Government clawed money back from them; I would be interested to know that.
	We know what is happening in the health service and we know why there is no Bill. Since this Government came to power we have seen creeping privatisation; no corner of the health service is untouchable as far as privatisation is concerned. Sometimes I just wonder what is going to happen in the next few years—God forbid if the Tories get elected again, with this lot here in charge. Are we going to be paying for our health service? Are charges going to be put on the health service? That is a good question to ask to see whether we can get a denial from the Government—

David Davies: rose—

Ronnie Campbell: Sit down, you will have your Welsh question in a minute. It would be good if the Minister could deny that he has any intention of charging for any services in the health service in the future, because they are creeping in little by little. As for the nurses—the people who run the health service and do all the work—their miserable wage rises are absolutely disgraceful and this Government should be ashamed of taking even that 1% away from them; they should get more but the Government are not even going to give them the 1%.
	Let us get back to the reality. This Queen’s Speech was the dullest one I have seen in my 27 years in this place, and I think everyone would agree on that. I sat down and I said to myself, “How can I liven it up? What if it was my Queen’s Speech? What if I jumped on the bike of my hon. Friend the Member for Bolsover (Mr Skinner)—although it has been pinched—and got into Buckingham palace to ask them to take my speech to the House of the Commons instead of the one they were going to read out?” My first Bill would be on the national minimum wage—I would put a Bill through to increase it to £10 an hour. My second Bill would be on a shorter working week—32 hours without loss of pay. My third Bill would call for full employment with no redundancies. There would be a repeal of all anti-union laws, and the reintroduction of collective bargaining.
	My next Bill would restore health and safety for workers. The health and safety budget has been cut by 35%, so we need a Bill to put that right for working people.
	My fifth Bill would bring an end to privatisation. There would be no more privatisation of the trains or the buses—[Interruption.] Never mind about the increases and the costs; this is my Queen’s Speech, not Labour’s. There would be no more asset stripping of public facilities. Bill No. 6 would be to get rid of Trident, which would make me popular, especially with the Scottish nationalists.
	My seventh Bill would put the buses and trains back into public ownership. It would try to stop the privatisation of the east coast main line, but I very much doubt that we can stop it now, as this Government are hell bent on getting rid of it before they go out of power. But we will restore it to public ownership—at least I hope we will; I hope that our Ministers are listening, and that we will restore it.
	My eighth Bill would bring education back under local democratic control. We have heard in the statement today how out of control things are. Local authorities are wavering. Their spending has been cut, and they have very little say over the academies or the free schools. Anything could happen in the education service now, because we no longer have that local watch, so we need to bring it back.
	My ninth Bill would be about the national health service. I want free public health care for all. That would be a big Bill and it would cost a lot of money, but we need to stop this creeping privatisation. I would get that money from one place: I would go to the City and tell all those spivs and bankers, “Your bonuses are stopped, because of all the money you have spivved off the working people of this country.” It is the working people who have had to pay for the austerity measures. I would tax those people and get the money for the Bills in my Queen’s Speech.

Gordon Birtwistle: The health service is very close to everyone’s hearts, and there are a lot of political gains to be made from it. I have to say that, as the Member of Parliament for Burnley, my election chances were boosted when Labour’s Secretary of State closed down our A and E unit. I am delighted to say that the coalition Government have now delivered us a brand new emergency centre in Burnley, which shows that the coalition Government have delivered good things, especially for the people of Burnley.
	There is one issue that I really want to talk about today. I have been a councillor for 31 years—I stood for election only last month and increased my majority over Labour in my ward—and the issue that has become very close to my heart is the care of elderly people. I am talking about elderly people who are on their own. People from companies call on them in the morning to get them out of bed. They stay for 10 minutes to make sure they are up and have had some breakfast. They then come back at lunchtime to make sure they have eaten some lunch, and then again in the afternoon to make sure they have had their tea. They come back in the evening. As one elderly man said to me, “They come back at 8 o’clock and tell me to get ready for bed.” He said, “I don’t want to go to bed at 8 o’clock in the evening. I am 87 years old. I fought for this country,
	and now they are telling me that I have to go to bed at 8 o’clock. I don’t want to do that.” What he wants is for someone to come and see him in the morning and talk to him. He is housebound, and he does not have a family. He is not the only one in that situation. There are many more like him in Burnley.
	We are a poor town and people cannot afford to pay for private services. These people want to talk to somebody in the morning when they get up; they want a bit of conversation. They do not want staff running in with their meals-on-wheels food in a foil container saying, “We’ll come back and see you later.” They want to talk to someone. They want to know that there is somebody who cares for them; somebody who is interested in listening to them. This elderly man has some fantastic stories about his life; I have seen him many times. When the staff come back in the evening, he is not asking them to stay all night. He is asking them to show a little bit of interest in him, and he certainly does not want to go to bed at 8 o’clock at night. He has never gone to bed at that time and for someone to tell him that he has to do so, “or he’ll be on his own” is wrong. I am not being political here. All I am saying is that we should care more for the elderly people of this country. I am talking not about people who are in their 60s, but about people who are in their 80s and 90s who, unfortunately, have been left on their own. They might be elderly ladies whose husbands have died. These are people who have worked for this country all their lives and fought for this country, and are now, certainly in my constituency anyway, being left alone. I find that hard to accept. I might be unusual. There might be people who think it is tough and bad luck, but I do not think that. We should be looking after these people and showing them some compassion. We are a wealthy country. Apparently, we are the fourth or fifth wealthiest country in the world, and the contribution that these people have made over their lives has helped to put us in that position.
	Burnley is an industrial town; we had the pits and the mills. Now we have high-tech industry where young people work and create wealth. Fortunately these days, they are able to put something aside for their pension, which will help to look after them in their old age. The elderly people from the ‘70s, ‘80s and ‘90s could not do that; they were on poor salaries. In the main, the wives did not work. My mother never worked. My father brought up our family, and my mother never worked. All right, my mother and father are dead, but there are still people around who were in the same position. Many have lost a partner and in the main their children are out of the area, and they need us to care for them. Is it a lot to ask for someone to turn up and say, “Hello, Mr Jones. How are you?”

Lyn Brown: The whole House is listening very quietly to what the hon. Gentleman is saying because it resonates. My father is 87. He pays for carers to come in from an agency. What has upset us is the fact that his life savings are paying the wages of people who drive Lamborghinis, who employ people on the minimum wage and who provide very poor care to the people the hon. Gentleman is talking about. This Government need to act to ensure that the care offered to our people, which they pay for out of their meagre savings, is of the quality that they deserve.

Gordon Birtwistle: I am grateful to the hon. Lady for her intervention. I do not know of a company that delivers services in Burnley that has an owner who drives a Lamborghini. In fact, I do not know anyone in my neck of the woods who has a Lamborghini. I do not know many people who can spell the word Lamborghini. At the end of the day, the hon. Lady is right: there are companies that are taking money, particularly from the state, and giving a very poor service. I do not want this to be a political point. What I want is to plead with the Minister and with the people in control—I am not in control, so I cannot deliver this—and say that we are living in an age where people are getting old and need looking after. Why can we not do a little bit more to look after these people? The people who get the sums of money to deliver this service should be a little bit more considerate and compassionate. They should not just walk through the door with a metal tray with a bit of food on that no one wants to eat, because it does not feel like the proper food they used to eat. Can we not just do a little bit more?
	My message today is: can we do a bit more people for our old people—the people who have put us where we are today, who have delivered the prosperity of this country over the years; and who have fought for us in wars? Can we not show them a bit more consideration? If those companies with Lamborghinis exist, can we lean on some of them to train people properly to ensure that they have a bit more compassion?

Paul Burstow: I hope my hon. Friend will forgive me for turning my back to him, but I want to tell him through the Chair that one of the places that is trying to do what he is talking about, and which I visited recently, is Wiltshire, which is using its relationships with contractors to drive out 15-minute contracting and drive up training standards, which is making a difference. That is happening now, and it needs to happen in more places.

Gordon Birtwistle: I am delighted to hear that, and I would like Wiltshire to become a standard that everyone else copies. I would hope that my constituency and the rest of Lancashire copies that. There are great companies—I know a few good companies that really care about the customer. These elderly people are customers: if Tesco treated people like some of those carers, they would shop somewhere else. Unfortunately, elderly people cannot go anywhere else, because a contract has been organised, and they have to use it. I urge the Minister to consider those suggestions and look at ways of improving the service that we deliver to our old people. I would be very happy if he did so, and I am sure that he would be too.

Norman Lamb: I completely agree with what my hon. Friend is trying to achieve. I hope that he is reassured that the Government have effectively introduced compulsory minimum training for all care assistants for the first time. I think he will welcome that.

Gordon Birtwistle: I do welcome it, and I am delighted to have heard that. I just hope that we make it a major condition of all Government and local authority contracts that all companies deliver that service to our elderly people. We will all become elderly—I am catching up very quickly—so who knows how soon it will be before
	someone comes to my house to say, “Gordon, it’s bedtime. It’s 8 o’clock—it’s toilet time.” That’s the worst thing I think I have ever heard—someone coming in and saying that it is toilet time. An old man said to me: “I do not want to go to the toilet, but I am told that it is time to go to the toilet.” It is just not acceptable to do that to an elderly man. I am delighted to hear what the Minister said, and I hope that we ensure that it continues in future so that we really respect and care for the people who have put us where we are today.

Angus Robertson: It is an honour to follow the hon. Member for Burnley (Gordon Birtwistle). The House was listening raptly to a speech full of humanity and compassion. I pay tribute, too, to the right hon. Member for Cynon Valley (Ann Clwyd), who read out a lot of examples of what everyone will agree was shocking treatment. I genuinely hope that Ministers listened closely to those speakers and to many others who have made important points.
	In the limited time available, I should like to draw attention to the obvious point that this is the last Queen’s Speech before the historic and exciting independence referendum in Scotland on 18 September. It is worth making the point that this Queen’s Speech and Westminster governance—the choices that the Government have introduced—can and should be seen through that prism. There are 100 days left before people in Scotland are able to determine whether we should become a normal country making all the normal decisions that successful democracies make.
	Today, we have been encouraged to speak about health, so I was pleased to find a recent international health watchdog report issued only a few days ago in Canada, which said:
	“Imagine a land where a patients’ charter of rights and responsibilities is in place that includes wait-time guarantees; over 90% of patients requiring elective care are treated within 18 weeks from referral by a family physician to start of treatment/procedure including all diagnostic testing and specialist consultations. Over 98% of in-patient procedures and day-surgery cases are treated within 12 weeks of agreement to treat. Over 90% of patients are seen within four hours in the emergency department (i.e., admitted, transferred or discharged). Citizens can access the most appropriate member of their primary care team within 48 hours. Up-to-date statistics and reports on wait times and health system performance indicators are publicly available. In addition to providing timely access, this land has been successful in improving other dimensions of quality of care (e.g., significantly reducing levels of hospital acquired infections, reducing the level of inappropriate care), and performance in all of these dimensions is being tracked through the measurement and reporting of performance targets available for use by patients, providers and system managers alike. Fortunately, this land already exists—Scotland.”
	That report was issued only a few days ago by the physicians watchdog in Canada.
	I pay tribute, as did the Health Secretary, to the work of health professionals, who make a tremendous difference to people in the NHS system in England and, no doubt, to the NHS system in Wales and Northern Ireland. I pay tribute to all of them, and in particular to those who work in NHS Scotland. I am proud of the difference that the Scottish National party Government have made since taking power in 2007. Staffing has increased under the SNP by more than 6.7%.

Tom Blenkinsop: Will the hon. Gentleman give way?

Angus Robertson: I have very little time, and I would like to make progress. The Government in Scotland have protected the front-line NHS budget—Labour said that they would not—and there is high patient satisfaction in the NHS. Obviously, there is always much to do, but 87% of people are fairly or very satisfied with local health services, which is an increase of 7%. We have seen the abolition of prescription charges in Scotland, which is extremely welcome. Prescriptions still need to be paid for in England, and I encourage the UK Government to consider following the example of the Scottish Government. A Scottish patient on a low income saves £7.85 per prescription, compared with a similar patient in England, and people with long-term conditions save £104 per annum compared with a patient in England, where there is provision for a pre-payment certificate.
	Free prescriptions are not the only advantage. Free personal care, which was championed by the former Labour First Minister in Scotland, Henry McLeish, has been introduced, and there is pride across the political spectrum in Scotland about that. Free personal care for the elderly improves the lives of over 77,000 older vulnerable people in Scotland, where personal care is free for people over 65 who need it. That kind of service would be beneficial for the kind of constituents about whom the hon. Member for Burnley talked so movingly. Of course, patients in England are not entitled to free personal care.
	Those are examples of better decision making and better outcomes, because in Scotland we have the ability in our Parliament and through our Government to pursue the policies that we wish to pursue, as opposed to those that are pursued by Governments whom we have not elected, such as those pursuing privatisation in the NHS in England. There is a concern about protecting budgets in Scotland against further cuts from Westminster and the austerity agenda that it is driving, which is why people are now talking about full financial responsibility. I looked closely at the Queen’s Speech to see how that might take place: all three UK parties have now said that they wish to see the transfer of further powers, notwithstanding the fact that only a few years ago there was a line in the sand. There were to be no more transfers but, lo and behold, when the SNP won with an absolute majority and a referendum was in sight, suddenly everyone was in favour of more powers. However, there were no specific proposals in the Queen’s Speech—reinforcement of the reality, if anyone needed it, that to have the powers to make a difference in people’s lives and build on the successes of devolution, we have to vote yes.
	I would wish the Queen’s Speech to include a series of measures that were not included: building and enlarging free child care; abolishing the bedroom tax; halting the further roll-out of universal credit and personal independence payments to create a fairer welfare system; simplification of the tax system to reduce compliance costs; negotiation of the removal of Trident nuclear weapons from Scotland; protecting the value of the state pension and putting more money into the pockets of pensioners; supporting enterprise in the economy by increasing personal tax allowances; making sure that the minimum wage increases at least in line with inflation; the creation of an oil fund so that we do not see the wasting of that natural resource, which can be there for future generations; and negotiating directly with the European Union to get a better deal for farmers and
	fishing communities. The list goes on. Those are all measures that could have been in a Queen’s Speech in Scotland if Scotland were in charge of all the normal powers that normal democracies are in charge of.
	This Queen’s Speech was totally empty of any of those proposals—proposals popular with the electorate in Scotland, proposals that can be brought forward if we use the power that is in our hands on 18 September. Between 7 am and 10 pm on that day the people of Scotland will have the power of Scotland in their hands. The simple choice for them will be whether we keep it or hand it back. I will be voting yes and I believe the majority of people in Scotland will do so too.

Phillip Lee: I shall take this opportunity in what is nominally the health debate on the Queen’s Speech to speak more broadly about the national health service. I welcome the fact that there is not much in the Queen’s Speech on health policy, because what we have done already under this Government needs to bed down.
	I have always tried to build cross-party consensus in the Chamber. At no point have I sought to make any party political points in relation to health care, primarily because, as a clinician who still practises in the health service and who has an extensive network of friends from medical school who are all approaching consultancy, I have been aware of the challenges that the NHS faces and have therefore always believed that there needs to be an understanding across the Benches for us to find the appropriate solutions.
	We need to get a grip of the NHS challenges that we face. Significant changes are afoot in our society—changes in attitude and behaviour, and patients’ expectations change as each generation passes away. A stoic wartime generation is being replaced by arguably much softer ones. Their experience of pain and their approach to suffering are different, in my clinical experience. Each generation is becoming more and more obese. As I have already said, the society we live in is ageing. There have been some poignant contributions to this debate. That is fine and I share the concerns, but let us not kid ourselves: more than 20% of the population is now aged over 60. The proportion of people paying tax compared with the proportion of people who have retired is diminishing. We cannot lose sight of that reality, and we need to recognise that change is inevitable.
	There are some welcome advances in medicine—in drugs, technology and the application of that technology to the care of patients—but these have invariably been expensive. The National Institute for Health and Care Excellence does a pretty good job of the cost-benefit analysis, but we are now saying no to drugs that enhance people’s lives. We need to reflect on that.
	The NHS was introduced in 1948 by Nye Bevan, who represented a constituency that I sought and, funnily enough, failed to take in 2005. At that time, the budget was £437 million, the equivalent of £9 billion in current money. We are approaching or may have touched above £110 billion per year. He said that there would be an initial expense when he introduced the service and that costs would then fall as the population became healthier. I am sorry—Mr Bevan might have been right to introduce
	the service, but he was wrong in thinking that the costs of that service would diminish with time. Clearly, they have not.
	What is there to do? I would say there are four things. First, we need to find a way of reducing demand on the services. This morning I attended an induction as I am about to start working at an urgent care centre in my constituency. It was striking to note who was coming through the door. The demand is great and it is growing, and we need to deal with it.
	Secondly, we must improve the physical structures in the system. Our hospitals are 19th and 20th-century buildings and we are trying, and at times failing, to deliver 21st-century care in those environments. We need to improve them and to do it fast. In order to secure an appropriate plan for our nation, I suggest that we need some sort of cross-party committee and cross-party understanding of where those acute hospitals will be in the future. We will have fewer of them, but we will have more community-based hospitals delivering chronic care. Let us not forget that over 80% of the NHS budget is now spent on chronic care. We need to make sure that that care is delivered closer to patients’ homes.
	In the future we will have telemedicine, which will deliver care in patients’ homes. This is the reality. It is already being piloted in Scotland, with some very good outcomes.

Angus Robertson: indicated assent.

Phillip Lee: We need to recognise that, but with that will come changes in hospital infrastructure and, yes, extremely difficult politics. We have heard about the difficult politics in south-west London, west London and elsewhere. That will be replicated irrespective of who wins next year’s election. The problem is here and now and we need to deal with it. All parties should put skin in the game and make a decision on where those hospitals should be.
	The third element is funding. This is the most emotive topic to discuss. Colleagues on the Labour Benches have proposed co-payments. From those on the Government Benches, there have been suggestions of health accounts and supplementary insurance schemes. There is a plethora of ways of funding health care—one only has to look abroad. In Norway people pay to see their GP; in Denmark they pay for their drugs at cost; in Germany there are supplementary insurance schemes; in France there are means tests, and the list goes on.
	I have not 100% decided what I think would be the right thing in future in this country, but the debate is needed. I cannot see how we can go above 10% of GDP on health care spending and balance the books across the whole of Government. Perhaps there are people who think we should spend north of 10% on that—fine—and approaching almost 20% on welfare if we include pensions. We are approaching £1 billion a day expenditure on these two areas. I do not think that is sustainable, but I know that if it is to change we need a cross-party debate on the matter. It is not easy.
	Finally, the political cycle does not help. We have heard how it helped the hon. Member for Burnley (Gordon Birtwistle) get elected at the last election, and I am sure this will be replicated on both sides of the House in future. There is no avoiding it. I have walked the walk in my constituency: I stood at the last election calling for the closure of my local hospital, because I
	know that if we consolidate services in my region, we get better outcomes. People live who otherwise would not live. People suffer less. I did not think it was appropriate for a clinician who had worked in the region in which he was seeking to represent a constituency to say otherwise. I thought it appropriate that I stood on that. I continue to stand on it and I continue to stand for the consolidation of acute services in my region and for chronic care to be offered locally to people.
	In conclusion, this country is very privileged to inherit a health care system that is pretty good. It is approaching first class by global standards, but it is a legacy that we must protect. Our grandparents have given it to us and we need to protect it in future, which means that we need to be open-minded about the changes required. I think the solutions will come from more than one political party and more than one expert group, but the time is now and we all need to work together.

Karen Buck: It is often in the specific and the particular that we understand how public policy is most effective, far more than in mission statements, PowerPoint presentations and the sub-sections of the legislation that we pass. That is particularly true of the NHS. We have heard two striking examples of that already in the contributions from my right hon. Friend the Member for Cynon Valley (Ann Clwyd) and the hon. Member for Burnley (Gordon Birtwistle) talking about social care. It is also true of the reconfiguration and change in the health service, which I shall address in the few minutes available to me.
	In many respects we understand across the piece what changes need to take place, yet we find that so many of the changes that have taken place at a higher level of public policy, particularly those implemented by the Government through the Health and Social Care Act 2012, have made it harder rather than easier to bring about the change that we need to deliver. In London in particular, an exceptionally complex environment, we saw that set out very clearly by the King’s Fund in its report last year, which made it clear that the Government’s reorganisation of the health service, carried out at considerable expense, had made it harder rather than easier to deliver the fundamental changes that we need by fragmenting its structure and undermining its capacity to introduce strategic leadership.
	In north-west London, which we have already heard mentioned today, we are facing one of the most fundamental changes in the delivery of health care since the establishment of the national health service. The “Shaping a healthier future” agenda is rooted in a set of principles with which most of us could agree. We want to reduce the number of accident and emergency attendances and, in particular, to reduce the number of accident and emergency admissions when patients can be better cared for elsewhere, particularly within primary and community services, and we want to reduce the length of stay, particularly for elderly patients who would be better and much happier to be cared for with appropriate social care support in their own homes. Those are undeniable facts that are supported by the general principle that in many cases the higher level of acute care is more efficaciously provided in larger and more specialist units. Those things go together and they are worthy objectives.
	It is in the detail of the implementation that we have a major problem. NHS England is apparently seeking to have a total of 780,000 fewer patients admitted to A and E over the course of the next two years. The “Shaping a healthier future” agenda translates into a reduction of 15% in the number of A and E admissions to be achieved in north-west London. As the King’s Fund’s health economist John Appleby has said, that is “not realistic or feasible”. The problem is not that it is not desirable or that we do not want to see it achieved over time, but that we are in the middle of a period of rising demand for A and E and the capacity simply is not there, either elsewhere in the acute hospitals sector or in community and primary care services.
	Only a few months ago, Imperial College Healthcare NHS Trust, at the heart of the “Shaping a healthier future” agenda, said:
	“We are yet to see any impact of primary care and community Quality, Innovation, Productivity and Prevention…schemes and therefore are planning to maintain the level of emergency care we provided”
	over the course of this winter. So, a hospital is saying that it cannot rely on the primary and community services being in place to divert people from A and E, yet almost in the same week the Secretary of State’s letter confirmed that the closure of the accident and emergency units at Hammersmith and Charing Cross, as we understand them, will go ahead as soon as possible. We now have a date in September, and his letter stated that
	“the process to date has already taken 4 years causing understandable local concern”.

Andy Slaughter: My hon. Friend has written a devastating critique to the new chief executive at Imperial about the fact that Hammersmith A and E in my constituency as well as other A and Es are being closed before there is appropriate provision to replace them. I would not hold my breath for a reply if I were her. I am still waiting for one to the letter I wrote to the clinical commissioning group on 26 April on the same subject of failure to provide primary care.

Karen Buck: I am grateful to my hon. Friend, who reinforces my exact point.
	Since the Secretary of State’s letter and the decision to proceed with the Hammersmith and Charing Cross closures, it has been reported in the Evening Standard that Imperial is having to use winter pressure beds routinely to cope with patients displaced by the planned A and E closures, admitting that there are “risks” of over-crowding, and warning that ill patients will have to spend longer in ambulances. This is a demand for winter pressure beds in the middle of the summer. The expectation is therefore that there is already insufficient capacity years before the construction of a planned new and improved A and E unit at Imperial hospital. The closures are going ahead and Imperial clearly cannot cope. An Imperial official said:
	“We have extra acute beds at St Mary’s Hospital, normally used during the busy winter period to ensure we can quickly admit those patients”
	in need. That is fine, but what will happen if and when we have a winter crisis or simply during the additional winter pressures? That capacity will not be available to help deal with them.
	None of this is meant to suggest that there are not fine people in clinical and managerial practice focusing their attention on ensuring that services are in place to assist with that transition, but the scale of the challenge appears to be beyond what can be achieved realistically within the timetable. In the middle of all this—and no doubt connected to it—there came halfway through the year a letter from the west London clinical commissioning groups announcing that they have
	“made an important decision to put funding into a central budget…£139 million…which means CCGs with a surplus will be supporting those with a deficit…We also agreed to explore how to bring together commissioning of primary care services across organisational boundaries”.
	That seems to me to be perilously close to the end of clinical commissioning groups as far as we understand them. My understanding was that clinical commissioning groups were designed to be rooted in their local communities, to work in effective local partnerships and to reflect the local service providers, particularly primary care service providers and patients, at a local level. That has all gone with the wind in west London and I am extremely worried about it.
	I am all the more worried because the whole transition programme is predicated on the delivery of improved social care, and it is social care with which we are now struggling to cope. In my local authority area, 1,000 fewer residents are getting social care than in 2010, and there will be a further £2.9 million cut this year. It is no surprise that the chief financial officer at Imperial trust, Bill Shields, has said:
	“The cynic in me says”
	that the proposal to take money away from the national health service to fund social care
	“is a way of taking money from the NHS and passing it on to the local authority…this will allow them to make good the cliff edge they have been through in the last few years and rebuild the local government public finances.”
	It would also mean
	“a significant real-terms reduction in NHS income…going forward”.

Andy Slaughter: My hon. Friend makes a point about this panicked attempt to find more money in the primary care budgets and slosh it around west London at any consultation, and that is exactly the issue on which I am still waiting for an answer. This is chaos in the health service and is a reaction to closure programmes that have been carried out on financial grounds and that have now reduced the health service in west London to a chaotic and dangerous state.

Karen Buck: It is extremely worrying because the whole thing is shrouded in a lack of transparency and a lack of effective communication about what is going on. The local authority is cutting its own social care funding and needs money to fill its black hole, whereas the trust at Imperial says that that is exactly what it is worried about. It says it is concerned about the transfer of money because that might not give it the increased local community services that would allow it to reduce emergency A and E admissions, which is what we want. In fact, those things are so far from being effectively integrated in a common purpose that the different sectors of the health service appear to be at war with each other financially, if not in any other way.
	The problem is that the fragmentation and delay caused by the reorganisation in the national health service since 2010 have undermined what should have been a sensible method of progressing and building up community services to reduce the pressure on the acute sector. Meanwhile, today and in the coming weeks my constituents will find that their hospital is at capacity but is expected to deal with the extra demand from the Hammersmith and Charing Cross accident and emergency closures, whereas the constituents of my hon. Friend the Member for Hammersmith (Mr Slaughter) face the loss of their accident and emergency units without any appropriate provision. It is a shambles, I am extremely concerned, and I hope it is not too late to ensure that we can put something in place to prevent a true winter crisis this winter that would be of the Government’s own making.

David Davies: Living in and representing a constituency on the border has given me a unique insight into the different systems that have now grown up in the NHS in Wales and the NHS in England. One thing has become absolutely clear—not just to me but to any independent organisation that has looked into this—and it is that the standards of care being delivered by this coalition Government are far higher in England than they are in Wales, where the NHS is run by members of the Labour party.
	The reality is that, judged on virtually any single indicator that one would care to look at, standards of treatment are better in England than they are in Wales. The waiting times for cancer have not been met in Wales since 2008; the four-hour accident and emergency target has not been met in Wales since 2009; the ambulance response times targets have not been met in Wales for 21 months; and in Wales the funding for the NHS from Labour, which claims to be the party of the NHS, has been cut by 8% while NHS funding has been ring-fenced in England.
	That has led to all sorts of situations. For example, an Opposition Member talked earlier about cancer in England. In England, of those people being diagnosed with cancer less than 2% have to wait longer than six weeks for their diagnosis, while in Wales 42% of people being diagnosed with cancer have to wait longer than six weeks to receive a diagnosis. The treatment times are also different; in Wales, people wait around 26 weeks, whereas in England the wait is just 16 weeks.
	Behind these dreadful statistics are a range of human stories. I was grateful to the Secretary of State for Health for allowing me to meet him with a constituent of mine, Mariana Robinson. She had been trying unsuccessfully to get treated in Wales for months and there was absolutely no interest in helping her. She wanted to be treated in England; she was one of many people who would rather be treated by this coalition Government in England than by the NHS in Wales. Finally, after a great deal of correspondence and after receiving advice from the Secretary of State in London, the NHS in Wales has finally relented in this instance, and Mariana will now be treated in Bristol. I am grateful to the Secretary of State for his help.
	Even this afternoon, while I was waiting to speak, I had yet two more e-mails from people who are totally dissatisfied with the treatment they are receiving in
	Wales at the moment and who would be prefer to be treated in England. I was contacted by an 88-year-old veteran who had served in the Korean war in the Fleet Air Arm of the Royal Navy. He is in constant pain at the moment and unable to sleep because of a problem with wisdom teeth. He has been told that he will have to wait nine months for treatment in Wales. I do not believe that such a thing would be allowed to happen in England, but he has been told that he cannot seek any treatment in England; he has no right to transfer his health care to a place where it can be provided more efficiently.
	Labour Members talked about the privatisation of the NHS. The Conservative party will never privatise the NHS; we have always believed that treatment should be free at the point of service. It is members of Labour in Wales who are responsible for supporting private health care, because they are putting patients in Wales in a situation where the only chance they have of being treated is to go and seek private health care. The 88-year-old veteran of the Korean war was told that if he wanted to have something done about the constant pain he is suffering, he would have to go private.
	I was also contacted today by a lady, the retired head teacher of a school in my constituency, who found a lump in her breast. She expected to be seen by someone almost immediately, as she would have been in England, but she was told that the first appointment she will have will be some time in late August.
	That is the reality of what is happening in Wales under a Labour-run NHS, and the Leader of the Opposition has said that we should “take lessons”—this is to quote him—from how the NHS is being run in Wales and try to implement them in England. My message today is to warn everyone, particularly Government Members, not to let these people be in charge of the NHS, because what we will end up with in England is longer waiting lists, slower ambulance response times, people not being diagnosed properly and no cancer drugs. Apparently, 150 people in Wales have died while waiting for heart treatment. It is an absolutely disgraceful situation.
	I have talked to Government Members about a suggestion that I made in relation to the Government of Wales Bill, which is to let these people put their money where their mouth is. If they think they are doing a good job with the NHS in Wales, they should allow patients in Wales and England to opt to go wherever they want to for treatment. At the moment, we have two totally separate NHS systems, so patients in Wales do not have the right to access treatment in England and, of course, patients in England could not go to Wales. A lot of patients in Wales want to be treated in England. I do not believe there are any patients in England who would want to be treated by the Labour-run NHS, but perhaps there are some out there who fancy waiting longer to be diagnosed and then waiting longer again to get the treatment that they have a right to expect.
	Let us see Opposition Members supporting a change to legislation that would allow patients in England to be treated in Wales, with the money required being added to the block grant given by the Government to the Welsh Assembly every year, and patients in Wales who want to be treated in England having the right to access that treatment in England, with the money required being deducted from the block grant that is handed over to the Labour party in Wales every single year. And let
	us see the direction of movement, because I know that an enormous number of people will immediately opt for the lower waiting times, the better diagnosis and the wider access to drugs that are available to people in England.

Geraint Davies: Does the hon. Gentleman accept that there are only 3 million people in Wales, and that when we compare Wales with a lot of the English regions and hospitals we do just as well? In London, we obviously have international centres of excellence. In Wales, we spend more cash per head. There is a sparser population and more nurses per 1,000 people, and we have better results on cancer than elsewhere, so there is a mixed picture. He is being completely political and undermining the morale of people working in the health service in his constituency; it is disgraceful.

David Davies: It is not a mixed picture at all and we should be very clear about that. People wait longer for treatment in Wales than they do in England. People wait longer to be diagnosed in Wales than they do in England. People wait longer for an ambulance in Wales than they do in England. Money for the NHS is being cut in Wales and it is being ring-fenced in England, because the NHS will be a priority.
	The real disgrace is that Labour Members have always prided themselves on being the party of the NHS and have gone out of their way to do so. Because they have that reputation, they know that in Wales, and possibly in England too if they ever end up running things, they can get away with making cuts and with cosying up to the unions because they feel that people will trust them.
	I say to anyone independent and impartial who wants to know what it would be like for NHS patients if Labour Members ever get into government, they should look at what is happening in Wales right now.

Andrew Gwynne: rose—

David Davies: I will give way to the hon. Gentleman even though he did not extend that courtesy to me or to anyone else from Wales.

Andrew Gwynne: Of course, people only needed to see the NHS at its highest satisfaction levels in 2010 to know what Labour in Westminster would do. I will correct the record on cancer waits, because of course Wales has a better record on cancer waits than England does: 92% of people in Wales are seen within 62 days, as opposed to 86% of people on this side of Offa’s Dyke.

David Davies: That is a fairly minor difference—[Interruption.] Oh yes. However, what the hon. Gentleman has forgotten to say, of course, is that those people in Wales will have waited far longer for the diagnosis of cancer than people in England. That is why he is not being entirely straight in putting his facts across. When he is winding up, I challenge him to say whether he thinks what is going on in Wales at the moment is good and something that Labour Members would like to aim for. Is what is going on in Wales what they aspire to?
	I urge anyone in the Opposition to look at The Guardian, which recently did an exposé of the NHS systems around the UK and showed that people in Wales have the longest waiting times of anyone in the
	United Kingdom, and that is the vision for the NHS that Labour Members want to impose on the people of England. I advise people in England to look at the figures before they decide to vote for Labour Members.
	I ask the hon. Member for Denton and Reddish (Andrew Gwynne) if he would be prepared to allow patients in Wales to be treated in England, and patients in England to be allowed to go and be treated in Wales if they wish to do so. I doubt very much whether he would support such a thing.

Andrew Gwynne: I am grateful to the hon. Gentleman for giving way again. He is obviously not aware that the number of English patients being treated in Welsh hospitals has increased by 10% since 2010.

David Davies: I am well aware of that, but the hon. Gentleman might not be aware that those patients have no choice. [Interruption.] He is laughing, but he does not understand how the system works. There are many patients on the English side of the border who are treated in Wales, but they have no choice about that. They have set up a pressure group, Action for our Health—he can look it up on one of his smart phones—because they are so disgusted with the service that they are getting in Wales that they want to be treated in England. The point is that they do not have a choice, and I believe that they should. Those English patients are very angry about the fact that they are treated in Wales and not given the choice.
	When the Secretary of State was talking about some of the things that have gone wrong in the NHS, I heard an Opposition Member shout, “He hates the NHS.” My right hon. Friend does not hate the NHS, but he does believe in putting patient choice and patient voice first. He believes in standing up for patients against vested interests, wherever they may be. I fully support him in that and commend him for what he has done. My only criticism of Ministers in this Government is that they have improved services in England so much that I have an enormous mailbag of letters from people who want to access the services that they have put on offer. If anyone wants to find out what would happen if Labour ran the NHS in England, they should look at the facts and figures for Wales.

Barbara Keeley: As this is carers week, I want to talk first about the impact that legislation and financial policy have on the one in eight people who are unpaid carers. We know that being a carer can have a significant impact on a person’s finances, career, relationships and, of course, health. Full-time carers are more than twice as likely as non-carers to have poor health, but sadly the pressure on them is increasing. Surveys last year told us that six out of 10 carers reported suffering depression, and nine out of 10 felt more stressed due to their caring role.
	Since 2010, local government budget cuts have led to funding on adult social care falling rapidly. By this March, local authority spending on adult social care had fallen by £2.68 billion in four years—a 20% fall. Those Government Members who have talked about funding today have nothing to be proud of when they
	reflect on that. Nine out of 10 local authorities now set their eligibility for social care at “substantial needs” or higher, compared with less than half of that in local authorities in 2005-6. Therefore, fewer people are receiving publicly funded care—300,000 fewer since 2008. Of course more of the care work load therefore falls on unpaid family carers, who in turn report suffering more stress and depression.
	Carers UK reports that the ever-increasing need for care and support in our ageing population will outstrip the number of family members able and willing to provide it. A carers week survey found that fewer than three in 10 people believe that they will become carers, but about six in 10 of them will have caring responsibilities at some time in their lives. Between the last two censuses, the number of over-65s providing care grew by 35%. Among carers aged 60 to 64, 54% of men and 36% of women who were caring were also in paid work. Therefore, the pressures on men and women juggling work with caring have intensified.
	Carers UK has found that one in five carers surveyed have had to give up work because either they were unable to secure flexible hours or their employer lacked understanding of their caring work load. Many carers then build up significant debts and have to cut down on basic expenditure, even on heating and food, to manage. This afternoon, I met a couple of carers at a speed networking event downstairs who told me exactly that. They had had to give up their jobs to care.
	Dr Jamie Wilson, a dementia physician, has said that
	“the financial welfare of carers should form part of a holistic assessment of needs. The combined effects of loss of income, additional costs of care and declining state benefits have led to an increasing impact on the resilience of carers and their ability to maintain the health of their loved ones.”
	The Care Act 2014 represents a wasted opportunity, because it places on local authorities a duty to assess a carer’s support needs, but it places no similar duty on the NHS. The Act makes it clear that a local authority can charge for the support provided to carers. I feel that the Government are failing carers in two ways. Giving carers new rights to assessment is meaningless when the support available is dwindling as a result of higher eligibility criteria and increased charges. A right to a local authority assessment is of little help to carers who have no contact with their local authority.
	At the meeting downstairs, I spoke with a carer called Caroline, who had come in with Macmillan Cancer Support. She has a multiple caring work load but has never been referred by her GP, or by any doctor she had ever met, to any sources of support. She only found Macmillan Cancer Support through a website. That is why identifying carers is so important. Macmillan’s survey of over 2,000 carers found that over 70% came into contact with health professionals during their caring journey, yet health professionals identify only one in 10 carers, with GPs identifying less than that. We cannot be smug or self-satisfied about that situation.
	The need for NHS bodies to identify carers and ensure that they are referred to sources of advice and support was raised at all stages of debate on the Care Bill in the Commons, but the Government did not accept amendments on the issue, so now we will need further legislation. Another weakness of the Act is that it restated the option for local authorities to charge carers for services. Carers’ organisations have repeatedly
	asked the Government to make it clear once and for all that local authorities should not charge carers for the support they receive. However, Ministers did not consider it appropriate for the Act to remove that discretion, which I think is a shame. I think that the Government are failing carers in a number of ways, as I have outlined. This carers week, it is time to show carers that we do value their caring.
	Let me touch briefly on a further aspect of health policy that relates to the attitude of NHS staff towards patients, as highlighted in the Francis report. An important source of improvement in that area is the social media campaign #hellomynameis, run by Dr Kate Granger. The campaign started 10 months ago, after Dr Granger’s admission to hospital, when she noticed that many health professionals did not introduce themselves when treating her. She spoke movingly at the NHS Confederation conference last week on the importance for patients and their care of getting the small things right. She pointed out that, in patient relationships, health professionals have most of the power, but they can make things more equal if they introduce themselves and explain what they are doing. She also explained the impact on her when doctors and nurses described her only as “Bed 7” or “the girl with DSRCT”—a rare cancer. As she rightly says, health professionals should always try to find out the patient’s name and how they like to be addressed.
	The #hellomynameis campaign has had great success on social media, but it deserves much wider backing. With 1.6 million people working for the NHS, we need to spread the message about the importance of treating patients as people. It should become routine for health professionals to think about a more courteous and human connection with their patients. I hope that shadow Health Ministers and Health Ministers will do all they can to support the campaign.
	Finally, in the short time remaining, I want to refer to my concern about issues caused for my constituents by measures in the Infrastructure Bill to allow fracking or shale gas exploration under properties without permission or appropriate compensation. The measure will have negative consequences for people with homes, farms or businesses adjacent to shale gas wells. We have had an exploratory shale gas well at Barton Moss in my constituency since November 2013. I have heard from businesses adjacent to the site that are losing money as a result and from constituents who have been trying to move but are finding it impossible to sell their homes. I have to tell the Minister that the offer of a £20,000 community payment seems paltry by comparison with the losses that my constituents have already suffered, even during the six-month exploration. The Government seem more concerned about a rush for shale gas than about the communities affected by the industrialisation of land caused by this process. We must have more caution and more consideration for our communities.
	I will end with a story that explains the difference between the NHS in 1997 and 2010. In the run-up to the 1997 general election, I met someone in Wythenshawe and Sale East who had been waiting two years for cardiac surgery and was worried that he would die while waiting. In 2010, in my constituency, I met someone who within one week went to his GP, was diagnosed and had specialist cancer surgery that saved his life. That is the difference a Labour Government did make and could make again.

Several hon. Members: rose—

Dawn Primarolo: Order. I regret to inform the House that more Members wish to speak than time allows under the current time limit. Therefore, to ensure that everybody gets in, I must now reduce the time limit to seven minutes. Even that is really tight, so Members might like to be sparing with their interventions, so that they do not slow us down.

Anne-Marie Morris: The Gracious Speech was an extremely fine speech, but I would have liked more work on the care agenda. The Care Act 2014 made a very good start, but there is more to be done. This concerns me particularly because Devon has the highest number of over-65s in the country, and my constituency has a very large chunk of that population.
	By 2035, 25% of the population will be over 65, 620,000 will be in care homes, 50% will have a sight impediment, and 75% will have a hearing impediment. Today, one in five over-80s has dementia, and that figure is set to double within the next 30 years. The demand is not going to diminish, while the supply is a real challenge for our society as a whole. Seventy-five per cent. of current need is met informally through the voluntary sector and by families. We must give thanks for that, but we then need to think about the financial contribution from the state. The NHS budget, which is now 8.4% of GDP, is in absolutely the right place—that is exactly what we should be spending given the current state of our finances—but the social care budget is decreasing and has decreased by 10% in real terms since 2010, if Age UK’s figures are correct. The reason is cuts in council funding. In my rural constituency, council budgets have been seriously hit, and I see the consequences day in, day out. Day centres in Devon are facing closure and support for supported living is being ripped out. This is a matter of great concern that must be addressed quickly.
	I welcome the 2015-16 better care fund of £3.8 billion, but will it be enough and will it be too late? Age UK says that £3.41 billion more is required if we are really to meet the need. I am a great believer that we do not solve everybody’s problems through money, so we must look at what we need to do. There is nothing more important than health and dignity in the ageing population. We need to look at what we, in a civilised society, believe good care should look like. We need a proper debate about who pays. Is it the individual, their family, or the taxpayer? We need to look at who delivers it. Is it the family, the voluntary sector, or the state? Clearly, it must be all those.
	The Care Act made a good start. It provided uniformity in the funding structure, consolidated the assessment process, capped costs, recognised carers and the need for support, put a duty on local authorities for care and well-being of our older population, introduced safeguarding adult boards and the star rating system—very good steps forward—and recognised that prevention is better than cure. In some ways, however, it was a missed opportunity. The commissioning process that decides what is ultimately purchased is not overseen. We still have a postcode lottery against which people’s only recourse is an individual appeal. We still have a conflict of interest in that our councils can commission and
	provide care, as many do. That has to change. On quality, star ratings are a good move. Let us remember that this is about relativity, not absolute quality. What are we paying for—brass or platinum? There is, as yet, no reassurance that wherever anybody lives they will get the fair share of care that they deserve.
	Staffing issues were not addressed. Best practice as regards staff and patient numbers is a ratio of 1:5, but the reality is more likely to be 1:7 given the budgetary constraints. No thought was given to trying to deal with some of the training concerns. Skills for Care is a voluntary programme. If we are going to make something really work, there has to be some stick and some carrot. I am pleased that we have a studio school in Torquay that meets some of the training needs and that the University of Surrey will introduce a proper foundation degree in 2015, but more is needed.
	Integration could have been addressed. This is not just about money; it is also about health and wellbeing boards. The King’s Fund suggested that there should be a requirement that providers are engaged in health and wellbeing boards. At the moment, only 30% are so engaged, and that needs to change. I am very pleased that in Newton Abbot we have a pilot on the frail and elderly that deals specifically with integration.
	There has been a missed opportunity for change, and change must come soon. We need to think about how to fund smartly. How can we increase the amount available to councils? After all, prevention is better than cure; otherwise A and Es and the NHS pay the price. How can we better support families to care for their elderly as we help them to care for their children? What can we possibly do in terms of time, flexibility and tax support? How can we support the voluntary sector? There is not an inexhaustible supply of volunteers, and they are fed up with the form filling that makes their lives burdensome. How can we reduce the capital burdens that councils face when having to deal with providing care? The capital cost of the homes and day centres is driving the closures. Let us work with social enterprise, housing associations and others to look for a better model.
	Let us improve quality and remove the postcode lottery. Let us, as we can under the Care Act, ask the Care Quality Commission to review the whole commissioning process. Let us look at what is provided by our county councils, what value for money we get, and whether it is the same across the country. What are we paying for? Are we finding that people in one county are getting bronze and those in another, where more money is allocated, are getting platinum? That cannot be right. Let us look, once and for all, at splitting purchasers from providers as we have in the NHS. Let us get rid of the potential bias that exists in this regard. Let us review the make-up of health and wellbeing boards and make sure that providers serve on them.
	Without proper resource, and that means people, we cannot get this right. We need to ensure that more nurses are trained and that they get the respect and the pay that makes them want to work in social care as much as they want to work in the NHS. Let us produce a proper career path that drives respect and reduces the fear they live in that they are going to be criticised for trying to do their best in an impossible situation. Let us enforce the best practice ratio of 1:5. Let us look at how we are going to fill the gap whereby unless one gets to a
	level of substantial need one will not be funded by the state. There is so much to be done and so little time. This has to be a priority for Government this year.

Hywel Williams: As a Plaid Cymru MP, it is something of a problem to respond to the Queen’s Speech on health matters, not only because it contained little about health in the first place but because health is largely devolved. Some time ago, when Alan Milburn was Health Secretary, I asked him about nurses’ pay, and he responded that he was eternally glad that he had no responsibility for things Welsh. He was wrong at the time, but now nurses’ pay is devolved. That is the measure of the problem that I face.
	On the whole, the content of the Queen’s Speech was rather thin, with little attention given to the growing challenges we face of rising inequality, regional disparities, and an economic recovery that is built on fairly precarious foundations. The impacts and consequences for Wales are fairly obvious because of our higher rates of sickness and disability, higher proportion of older people, and greater needs in respect of poverty. Hon. Members may have seen today’s report on child poverty, which paints an alarming picture and casts doubt on the Government’s ability to reach the 2020 target of eradicating it. I think that that is now beyond reach, unfortunately.
	Given the nature of the Queen’s Speech, I fear that the coming year will be a matter of treading water. For Wales, we have the continuation of the Wales Bill, but we also have missed opportunities. There are matters of particular concern to Wales, not least the funding of the Welsh Government. I also fear that we will see further dismantling of the principles of the welfare state, dismantling of public services, and a failure to address the deep structural economic weaknesses that we have, with a recovery that is driven by an increase in personal debt and spiralling house prices in the south-east and in London, and continues, I am afraid, the UK’s long-term imbalance that has devastated the economy in Wales, in parts of England, and indeed in Scotland.
	Plaid Cymru put forward an alternative Queen’s Speech with Bills that we would have liked to be included. The Bills have principles central to Plaid Cymru’s vision for Wales, which is built on equality, prosperity for all, and social justice. We have 10 ambitious and workable Bills founded on strengthening Wales’ economic position and its position in terms of democracy, and on improving the lives of our people, not least in respect of health outcomes.
	When the pension tax Bill is before the House, we will call for proper consumer protection for people who will have large pots of money at their disposal, as the sharks are already circling. We are extremely glad that the Government are introducing the modern slavery Bill. We also welcome the legislation to strengthen the law in relation to child neglect and organised crime.
	We particularly welcome the Bill to strengthen the complaints procedures for the armed forces. We have campaigned for a very long time on veterans’ issues, particularly post-traumatic stress disorder. We support the proposed measure and hope it will prevent ex-service people from suffering mental distress and psychiatric conditions, which have resulted in so many of them ending up in the prison system.
	Other Bills are appealing at first glance. A case in point is the heroism Bill, which seems likely to garner good headlines in certain sections of the press, but I share the TUC’s fear that it will have a bad effect on health and safety legislation and working conditions in particularly dangerous industries.
	Turning briefly to our own propositions, we would have liked an economic fairness Bill aimed at levelling up the growing wealth inequalities that exist on both an individual and geographical basis in the UK, which is the most unequal state in the European Union. Such a Bill would mirror that part of the German constitution that commits to regional equalisation and prioritises poorer areas for infrastructure and foreign direct investment.
	We would also have liked a Bill to ensure that Wales is fairly funded on the basis of need. It is a long-standing complaint that Wales is underfunded to the tune of £300 million to £400 million, as identified by the independent Holtham commission. Every year, Wales loses that amount of money. The cumulative total has had a clear, bad effect on our economy and it is an ongoing injustice. More than that, it actually constrains the Welsh Government and what they can achieve, forcing them to choose between essential spending on health, education, economic development and many other desirable targets of expenditure. The effects of underfunding are seen throughout Wales, not least in our health service, but on this issue the coalition Government in London are deeply compromised as they chastise the Welsh Government for their undoubted failings in health, while at the same time denying them the resources and means to address those failings.
	We were greatly disappointed, though perhaps not surprised, that the Government botched the chance to end zero-hours contracts, particularly in the care sector. We would have liked an employment rights Bill to adopt measures to protect and empower workers.
	I will catalogue the other measures we would have liked to see, including a natural resources Bill transferring responsibility for all of Wales’s natural resources from the Crown Estate and Westminster to Wales. We would also have liked more direct support for the tourism and hospitality industry and, lastly, a Welsh-language provision Bill to strengthen the requirements to provide services in Welsh, particularly by private organisations working without Wales into Wales. In respect of this debate, I point specifically to private organisations providing health care in England.

James Duddridge: Sometimes we in Westminster get obsessed with the minutiae and detail of Bills and Committees, but our constituents do not have the same obsessions. As the Institute of Directors has argued, it is better to focus on a small number of Bills. A Volkswagen car salesman gets obsessed with the latest VW model, but the general public just appreciate better, cheaper cars. An engineer gets obsessed with a new widget, but the general public just want the machines to work. Our constituents do not get obsessed with Bills, how many of them there are, or whether they are nuanced towards the left or right. What they care about is that we get things right—and we are getting things right. One could argue that things are not happening quickly enough, but 1.5 million new
	private sector jobs is a darn good start. Is the reduction of the budget deficit by a third enough? No, it is not, but it is a darn good start.
	This debate is a little bizarre, in that it is on health, even though health was not in the Queen’s Speech. The people on the doorsteps of Rochford and Southend East have not said to me, “Mr Duddridge, what we need is a new Bill on the health service.” In fact, I would wager that one or two constituents in every constituency would say that we have had far too many Bills on the national health service over the years, including recently. Having set out on this strategic direction in the NHS, it is right that we stick to it, bringing GPs closer to the broader care of individuals and bringing together social services and more traditional NHS care.
	The NHS is a great British institution. When I was a teenager I attended religious education classes with a vicar, who asked: “If you didn’t know whether you were going to be born to a rich or a poor country or to a rich or a poor family, whether you were going to be fully able or disabled, or whether you were going to be healthy or suffer from ill health, where would you want to be born?” I say to this House that I would want to be born here in the United Kingdom, and one of the reasons for that is the national health service. When my son and grandparents were ill, they would not have received care anywhere near as good elsewhere. Yes, one or two places might have a slightly flasher health service—at double the cost—with shinier bells and whistles, but when a member of my family was ill I remember being told: “Internationally, the hospital in the States is very good, but the hospital your family member needs is the one they are going to, because it is the best in the world.” I think we are all grateful for that.
	My hon. Friend the Member for Bracknell (Dr Lee) made an eloquent speech and he knows far more about the health service than I do, but he seemed to want politicians to coalesce and form a view that one Member’s hospital should close and another’s should be extended. That is part of a responsible debate in the House, but we truly need to trust health professionals. Southend has a particular problem with its stroke unit, which has historically been very good. The Basildon stroke unit started off from a lower base point, but stroke doctors across south Essex tell me that what south Essex needs is a single, hyper-acute stroke unit. We need to trust health professionals across the board.
	I was going to make a speech about pensions on Wednesday, but I am making a speech about health today because I am going to meet the chief executive of Southend hospital on Wednesday. Despite health being one of the two ring-fenced areas, there are serious pressures. My hon. Friend talked about changes in pain threshold and people’s demands, but we cannot meet all those expectations. We need to have a balanced national debate about what we can do and the best way to do it.
	Turning to other provisions, I welcome the private pensions Bill. If the Whip on duty is listening, I would very much like to serve on the Committee. I cannot imagine that many Members will volunteer and suspect I have already secured my place. More than 12 million people have underfunded pensions. It is a serious issue. The Chancellor has taken some useful first moves on annuities, allowing greater choice for people coming out of pensions, but greater clarity is needed for those going into pensions.
	Having previously worked in the investment and pensions industry, I know that all too often Government tinkered with the system and layered in cost for people who had only a small amount of money to invest. People often discuss the pensions of those on fat cat salaries, but most people’s pensions amount to managing only thousands or tens of thousands. A clearer, collective instrument that shares risk—greater risk can be taken when shared by a number of people—will be worthwhile.
	I am not going to rewrite the Queen’s Speech like the hon. Member for Blyth Valley (Mr Campbell). I am not sure whether he was being real Labour, old Labour or a socialist, but I saw Members on the Opposition Front Bench give him welcome looks when he said that his speech was not Labour party policy. It would in many ways have helped Conservative Members if it had been Labour party policy.
	One small change that I would have liked is a help to rent Bill. There are 15 million spare rooms in the United Kingdom. I am not talking about Opposition Members’ incorrect use of the term, but of spare rooms in houses that are owner-occupied and perhaps under mortgage. Not everyone wants to rent out a spare room to somebody, but the spare room relief of £4,250 has not been changed since 1997. Rather as we are doing with council and housing association property, we could release some of the spare rooms in owner-occupied houses by making it more financially advisable to rent out a room. There is nothing wrong in taking in a lodger—

Dawn Primarolo: Order.

Mike Gapes: For the first time in my life, I live in a majority Labour council in the borough where I was born. On 22 May, Redbridge—

Chris Ruane: Aptly named.

Mike Gapes: Yes, it is now. That is true.
	In a borough established in 1964, for the first time we have 35 Labour councillors, with 25 Conservatives and the Liberal Democrats declining to just three.
	I want to highlight an issue that I had hoped the Secretary of State for Health would have been on the Front Bench to hear in person. I do not think that he appreciates its seriousness, given that this leaflet might have changed the result in the ward where it was distributed. The leaflet said:
	“Official announcement from the Health Secretary
	Whilst calling on residents over the last few weeks it has become clear that the most important issue is the proposed closure of King George Hospital A&E. Lee Scott MP together with the Conservative Councillors have pressured the Health Secretary into clarifying the situation. Please read his statement overleaf. The position is now very clear:
	KING GEORGE HOSPITAL IS NOT CLOSING
	KING GEORGE A&E IS NOT CLOSING
	Ruth Clark, Vanessa Cole, Thane Thaneswaran”.
	They were the candidates of the Aldborough ward of Redbridge borough in the Ilford North constituency. On the other side is a statement issued by the Secretary of State for Health.
	I heard about the leaflet because the local newspaper, the Ilford Recorder, put on its website a story with the heading, “King George A&E to remain open beyond 2015, says Heath Secretary”. That was published on 20 May. Members know the rules about purdah very well. I immediately phoned the Department of Health and asked whether a press statement had been issued by the Secretary of State that day. I was eventually referred to somebody in the press office—it took a little while—who said, “We have made no statements of any kind today.” I said that it had been reported by the Ilford Recorder that there was a statement by the Secretary of State for Health. I had not seen the leaflet at that point, but I got a copy of it later.
	The press office said that it would refer me, if I so wished, to somebody in the private office who would call me back. I did not get a call from the private office—I did not really expect one—but I decided to get to the bottom of the matter. I have written to the permanent secretaries in the Cabinet Office and the Department of Health to ask for an inquiry into whether any officials, civil servants or Ministers were involved in the leaflet issued in Redbridge.
	I hope that the Minister will convey to the Secretary of State that I give notice that I shall write directly to him after this debate to ask, under freedom of information legislation, for all the information about what contacts, if any, there were between officials, advisers or SpAds—special advisers—in the Department with councillors in Redbridge or anybody else about the publication of the leaflet before the election. As it turned out, Labour won all three seats in Aldborough ward and it was successful in winning control of the council, but it is clear that the leaflet was designed to influence the result of the election.
	When I raised this matter in the business statement last week, I was told by the Leader of the House that there “was no announcement”, and that the leaflet was just a restatement of existing policy. When I made a point of order earlier, I could not quite hear what the Secretary of State said, which was why I raised it again. I will have to read tomorrow exactly what he said, but I think that he said that the leaflet was a statement of existing policy. If so, why was a leaflet put out that said:
	“KING GEORGE HOSPITAL IS NOT CLOSING”?
	Under the existing policy, enunciated on the Government Front Bench in 2011, both the maternity and accident and emergency departments at King George hospital were to close in about two years’ time. Maternity services closed last year. The A and E closure was supposed to be by 2014, and then it slipped to 2015 because of the chaos, the deficit and the fact that the Barking, Havering and Redbridge University Hospitals NHS Trust, covering both Queen’s and King George hospitals, has been put in special measures, and we now have yet another chief executive to add to the litany of chief executives over recent years who were supposed to have solved the problem. It is a shame that the hon. Member for Monmouth (David T. C. Davies) is not in the Chamber, but perhaps he could come to Redbridge to appreciate what services are under a Conservative Government.
	The reason the A and E department has not been closed is because it cannot cope with the existing pressures, and it would not be safe to close it. We have a growing population in north-east London, with very large numbers of young people and children, and a large migrant population. There are therefore enormous demands on
	services. We have relatively poor GP services—we still have single-handed GPs in some areas—so we cannot expect people to go to a GP. Many people are not registered or are temporary, and they therefore turn up at the hospital. These fundamental and deep-seated problems must be resolved before we can start to take away services. The people of Redbridge understand that, which is why there is a campaign to save our A and E at King George hospital.
	I will continue to pursue this issue until I get to bottom of the complicity of someone in the Department in issuing the leaflets that were designed to mislead the public in the few days before the election. I assure the Minister that this will continue until I get the whole truth.

Sarah Wollaston: May I start by paying tribute to my predecessor, Anthony Steen, for his tireless work in bringing in a modern slavery Bill?
	Today, however, is for talking about health, which is a great passion for me in this place and outside it. The NHS touches people’s lives 1 million times every 36 hours, which is a staggering figure. I believe that the NHS is worth every penny of the nearly £110 billion that we spent on it in the last financial year. I am very proud that this Government have protected the health budget, but that does not of course mean that there are not enormous financial pressures. We are now in the fifth year of effectively near-flat funding, and the issues set out by the hon. Member for Ilford South (Mike Gapes) are part of those pressures. We know that whichever Government were in power, there would have been serious challenges.
	If the NHS is to be sustainable, we need to listen to the new chief executive of NHS England, Simon Stevens, who has called on all staff members to think like a patient and act like a taxpayer—we must do that to get every ounce of value out of our NHS—and to address issues of patient safety and of how we keep people out of hospital in the first place and get on with implementing the measures. The nature of the challenge has been set out in exhaustive detail; now we need to get on with the measures that have been put in place to help to prevent hospital admissions, to treat people at the right time in the right place, and to integrate health and social care. I want us to look carefully at the better care fund and the plans for getting best value out of it, and at the issues of patient safety that were mentioned earlier.
	Given the absence of much legislation in the Gracious Speech, there is one regret that I want to point out: the absence of the Law Commission’s draft Bill on the regulation of health and social care. I hope that in summing up this debate, the Minister will give some reassurance that he can use secondary legislation to bring forward at least some of the measures in that draft Bill. It covers issues that touch 1 million people across 32 professions that are covered by nine regulatory bodies. Unless we clarify the language so that there is a common language in respect of patient safety across all those regulators, it will be difficult to implement some of the core messages from Francis and to act quickly in response to emerging threats to protect the public.
	Every year for three years, the Health Committee has called on the Government to allow the General Medical Council to appeal panel decisions that clearly have not
	protected the public. Likewise, the Nursing and Midwifery Council would like powers to reopen cases in which it has been judged there is “no case to answer” if serious new evidence emerges. Alongside that, the General Pharmaceutical Council would like to implement transparency and to able to take enforcement action. Those are all simple measures that I hope the Minister will mention in summing up. I also want the unacceptable level of delays to be addressed.

Norman Lamb: I want to give a quick confirmation that we will do what we can through secondary legislation to do what the hon. Lady requests.

Sarah Wollaston: I am very pleased to hear that.
	There will not be an absence of debates on health in this place. Two Bills will probably come here from the Lords in this Session: the Medical Innovation Bill and the Assisted Dying Bill. I will briefly put some of my concerns about the Medical Innovation Bill on the record while there is time for it to be amended. I have no doubt that it was introduced with the best of intentions to bring forward innovative treatments. However, I fear that it will have the reverse effect: it could undermine research and open the door to the exploitation of people when they are at their most vulnerable.
	Currently, clinical negligence law provides redress for patients who have been harmed as a result of treatments that would not be supported by anybody of medical opinion. There is insufficient evidence that doctors are not introducing new treatments or are put off from doing so because of the fear of litigation. The NHS Litigation Authority has made it clear that doctors are protected from medical litigation in that respect. However, the briefing note for the Saatchi Bill talks about a doctor being able to use a novel treatment if he is “instinctively impressed” by it. In other words, doctors will be able to use an anecdotal base for treatments, rather than a clear evidence base. There are dangers in going down that route.
	There have been some amendments to the Bill. Lord Saatchi has accepted that a doctor should have to consult colleagues and their medical team, but not that they should consider a body of opinion or consult ethics committees. I fear that we could be turning the clock back. We should rightly be proud of the advances that we are making in the field of medical research. We should rightly be proud of the push towards greater transparency, particularly in respect of open data and drug trials. However, I fear that if we allow people to access innovative treatments that have no evidence base, we will open the door to the purveyors of snake oil, rather than those who want to allow patients to enter controlled trials to establish a clear medical evidence base.
	We should not underestimate the extent to which the purveyors of snake oil are out there. I put on the record my congratulations to Westminster city council and its trading standards department on fighting two successful prosecutions under the Cancer Act 1939 against two individuals, Errol Denton and Stephen Ferguson, for peddling so-called nutritional microscopy to people who were at their most vulnerable—cancer patients and patients with HIV—and telling them that it was an alternative to evidence-based treatments.
	We must therefore be careful in how we move forward with such legislation. We should take more notice of the concerns of the Medical Research Council, the Wellcome Trust and the Academy of Medical Royal Colleges, who feel not only that the Bill is unnecessary, but that it could turn the clock back on evidence-based medicine. I hope that the Government will look at the concerns that have been expressed about the Bill in its current form.
	Finally, Lord Falconer’s Assisted Dying Bill would enable competent adults who were terminally ill to have assistance to end their lives, but it would require the involvement of a medical practitioner. Although the Bill comes under the responsibility of the Ministry of Justice, it would have profound implications for end-of-life care and medical practice. It would fundamentally change the relationship between doctors and patients. There is a risk that the right to die would slide into a duty to die. I have seen how often patients who are towards the end of their lives fear being a burden on their families, and they often go through periods of profound depression. I do not feel that this Bill is the way forward.

Lyn Brown: It is wonderful to follow the hon. Member for Totnes (Dr Wollaston), and I totally and utterly agree with her concluding remarks.
	Some may say that the absence of any reference to health legislation in the Queen’s Speech is a blessing; after all, the unwanted top-down reorganisation foisted on the NHS by the coalition and the previous Secretary of State is said by many to have put such a strain and stress on the NHS that it has been brought to its knees. Many Members present will know from their casework, inboxes, surgeries and personal experience that there is a rising tide of public concern about the NHS because of the lack of accountability and because decisions are being made upstream from local services. Our constituents may well view the absence of any mention of health in the Queen’s Speech as evidence of complacency, disinterest and unconcern. I have to say that I would agree with them. The Government have taken away the local means to secure improvements in services, and in this Queen’s Speech they have missed an opportunity to bring back local focus and accountability.
	I want to look first at GP provision. One of my constituents wrote to me in April out of “sheer despair” at her inability to get an appointment at her surgery for an issue that she has said is not urgent. She has a busy job, is at work at the times she needs to call the surgery, and cannot leave work at the drop of a hat should she be offered an on-the-day appointment. As she put it,
	“the current system is an absolute joke, to put it mildly…this current NHS system is completely useless”.
	My constituent needs and deserves Labour’s GP access guarantee. Is there anything like that in the Queen’s Speech? The short answer is, “No, there is not, but there should have been.”
	My constituents do not have the same access to GPs as people in other areas. Building on NHS England’s most recent survey, the Royal College of General Practitioners shows that 16.82% of patients in Newham were not able to get a GP appointment when needed, compared with 5.36% in Bath and North East Somerset.
	The Government should adopt the GP access guarantee to address those inequalities, and the Queen’s Speech would have been the right place to introduce such proposals.
	Before its abolition, Newham primary care trust had a clear plan to tackle and improve the challenging local situation, of which I was an active and enthusiastic supporter. Today, I am far less sure that mechanisms are in place locally that have the capacity and motivation to root out poor practice and promote the best. My misgivings were confirmed when I asked who now decides what to do when, for example, there is a vacancy at a GP practice in Newham. The answer came back—I still find this astounding—that the decision rests with NHS England. What is more, I was told that the London office of NHS England has a small number of people who deal with the provision of GPs, dentists, opticians and pharmacists. They must struggle to keep up with the paperwork, let alone have any capacity to look at proactive work on quality, improvement and service development.
	What local knowledge can NHS England have about what is happening on the ground in Newham? How can that make any sense, and how is NHS England accountable to Newham’s people and its clinicians? What does it say about the reality of this Government’s commitment to localism? It is surely a matter of great regret that the Secretary of State did not seek to use this Queen’s Speech to address some of those very real issues.
	In his response, the Secretary of State will no doubt include fine rhetoric about control being in the hands of GPs locally through the clinical commissioning group. He will laud to the skies their skills, commitment to patients and the NHS, and their virtue in all respects. I have talked at length to my CCG in Newham and worked closely with it, and I assure the Secretary of State that I share his opinion of its estimable qualities. In fact, I would add more approving words to his glowing testimony. I also know, however, of the CCG’s absolute frustration at the straitjacket that the new NHS structure requires it to wear, and I share its recognition that the reality of local empowerment is very different from that described by the Secretary of State and enforced with the diktats of NHS England.
	The new structures leave decisions in the hands of NHS England. Surely the current Secretary of State can see that that is nonsense. In his calm, perhaps even reflective moments, I think that he knows and would admit that, if only to himself. What a shame that he did not use the Queen’s Speech to intervene and turn his rhetoric of localism into more local control over NHS decisions.

Valerie Vaz: It is a pleasure to follow my hon. Friend the Member for West Ham (Lyn Brown). I am pleased to speak in this debate, and let me clarify if I stray slightly off topic that it is a tradition that one can be wide-ranging in one’s comments, but I will return to the NHS.
	In my view the British people do not deserve the Gracious Speech as delivered. The first sentence contains a contradiction. It states that the Government
	“will continue to deliver on its long-term plan to build a stronger economy and a fairer society.”
	What is the evidence so far? So far there has been a tax cut to 40% for those earning more than £150,000, while at the same time some are struggling to pay the extra rent for the bedroom tax or a spare room. Those are among the most vulnerable people in society.
	Added to that is a continued assault on the public sector, and as we start the new session, there are still unanswered questions about the Royal Mail privatisation. There are plans to privatise the Land Registry, for which there is no case to answer, in addition to other cuts in the public sector. The Land Registry, the possibility of the east coast railway, the Forensic Science Service, the scientists at Kew Gardens—all that is the Government interfering with services that are profitable, safe and should be left alone to carry on with their expertise for future generations. Even the chief inspector of Ofsted has said that he will end its contracts with third-party services and employ school inspectors directly, because he thinks it is too important. So are all those other services and so is the legal system, but that does not seem to bother this Government. This is a giant jumble sale of the public sector.
	The Gracious Speech contains a statement about selling off-high value Government land—land and assets that belong to the British people will be gone for ever. Members may remember the selling off of cemeteries for 3p by the former leader of Westminster council. The Government do not need to sell off high-value Government land for housing because that can be done by building on land where there is already planning permission. People in this country can use their creativity to find new ways to design new homes and build them, such as the programme developed by Walter Segal where people on the housing waiting list in Lewisham were taught how to build their own homes. That gave them expertise and empowered them, and the houses were sustainable.
	My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) is right when she says that the Gracious Speech will allow fracking under people’s homes whether they want it or not. There is no definitive evidence that fracking works. Some 75% of the chemicals used in fracking are toxic and 25% are carcinogenic. There are concerns about its effects on the environment and on public health.
	As many Members have pointed out, it is no coincidence that the Gracious Speech is silent on the NHS. Instead, the Secretary of State wants to punish the very people who have borne the brunt of the reorganisation that, by conservative estimates, amounts to £3 billion. He says they cannot have a 1% pay rise. He is withdrawing funding from front-line services, such as GPs’ minimum practice income guarantee, which affects surgeries in places such as Tower Hamlets and some rural practices, and which will be withdrawn from Wales a year later. The Secretary of State cannot blame the Welsh Assembly Government for that.
	There is a lack of doctors in A and E because they are going abroad. Where is the long-term plan to end that crisis? Where is the Secretary of State’s response, other than leaving it up to NHS England? The lack of accountability, which was pointed out by my right hon. Friend the Member for Leigh (Andy Burnham), has been exposed since the implementation of the Health and Social Care Act 2012. Nothing has been done. Instead, we get announcements about community hospitals without consultation with local people about which
	hospitals are needed and where they should be placed. The Government want to use public money in their own way, but they do not want to be accountable for it.
	There is a provision, as other Members have pointed out, for redundancies to be capped. The revolving door and merry-go-round of people being made redundant and then rehired as consultants has been exposed time after time by Her Majesty’s Opposition. That public money could be used for my constituent Grace Ryder, aged 9, who was recently diagnosed with type 1 diabetes. She wanted to draw attention to this and raise money for charity, so on Saturday she helped to organise a fair at Delves Baptist community church. This courageous girl has to wear a cannula in her stomach for the delivery of insulin. There is an alternative—a pod that has no tubes—but it is not available on the NHS and the family cannot afford the £90 per week that it costs. Instead of these vast redundancy payments, money should be spent on the courageous Grace Ryder and other children to help them lead as normal a life as possible. I would ask the Secretary of State, if he only bothered to listen, whether he is as courageous as Grace Ryder. Can he make this insulin pump available on the NHS?
	To promote a fair, just and more equal society we need to tilt the balance back to the British people. The Government should look again at the scaling back of the Equality and Human Rights Commission and the equalities agenda. The organisation was there to help and to provide evidence for some of the myths that abound that may explain why some communities are not tolerant of each other. Her Majesty’s Opposition will repeal the Health And Social Care Act, which has caused chaos, insecurity and inequality in the NHS and repeal section 75, which forces competition, not collaboration, wasting millions of pounds on legal advice. We will also build affordable homes like those built under the vision of Walter Segal, which became a reality in Lewisham. Equality, opportunity, justice and tolerance should be the foundations of the Gracious Speech and our society.

Andy Slaughter: I am sorry that this debate began with a speech that was smug and complacent even by the standards of the Secretary of State for Health. I thought we had reached a low point until I heard the hon. Member for Thurrock (Jackie Doyle-Price) using a speech on the NHS to promote the tobacco industry. I am glad that those speeches have been balanced by those we have just heard from my hon. Friends the Members for Walsall South (Valerie Vaz) and for Westminster North (Ms Buck). Indeed, the speech from the shadow Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham), reaffirms Labour’s commitment to the health service, which is fairly lacking from this Government.
	I am going to speak about the crisis in the west London health service, partly because it is such a major crisis and partly because I think it indicates the way the Tories are dealing with the health service generally. It began two years ago, almost exactly, with the announcement of the biggest hospital closure programme in the history of the NHS. Since then we have had sham consultations with 100,000 people petitioning and being ignored, U-turns, confusion, incompetence, refusal to answer
	questions and political chicanery to make what happened in Ilford, as we heard from my hon. Friend the Member for Ilford South (Mike Gapes), look like a model of probity. Now we have the contamination of the whole NHS locally, including the primary care sector.
	When the closure programme began, the medical director of North West London NHS said, candidly, that if it did not close four A and Es and two major hospitals, it would literally run out of money and go bankrupt. Those are the words he used. I suppose we should be grateful to him, because those statements galvanised the population of west London to engage in “save our hospitals” campaigns, and they have been campaigning for two years in rain and snow. Despite huge disinformation paid for by the taxpayer, by a Conservative council and indeed by the NHS, when I now stand in Lyric square in Hammersmith on a Saturday, I can be sure that 99% of my constituents know what is actually happening. I pay tribute to those campaigners from all political parties—including a lot of ex-Tories, as well people from minor parties, Labour supporters and others. They have really made the running on this issue.
	Yes, there were changes. Initially, for example, we were going to lose the whole of Charing Cross hospital. Now there will be a local hospital on the site. When that was first mooted, a senior member of the local Conservatives and a Cabinet member said:
	“This is an enormous teaching hospital with a 200-year history. You can’t make the Charing Cross hospital into a local hospital. It’s absurd. People won’t put up with that.”
	Within weeks, they were spending ratepayers’ and taxpayers’ money putting out leaflets saying that Charing Cross hospital had been saved. That was compounded last October when the Secretary of State for Health stood here and effectively said, “Oh, it won’t just be an urgent care centre. It’ll be a second-tier emergency department.” Let me clarify the three differences between those two: recovery beds, X-rays and GPs. I thought we had GPs on duty in urgent care centres, but apparently not; we can just have nursing cover. It is an urgent care centre by any other name; to call it an A and E is misleading. It will lead to people with serious medical conditions going there and risking their and their family’s lives—as we have already seen at Chase Farm and elsewhere. Charing Cross and Hammersmith will not have blue-light emergencies—except for heart attacks in the case of Hammersmith. We will not have a stroke unit; we will not have the 500 emergency beds; we will not have intensive treatment. This is a second-class, second-tier health service.
	The worst transgression happened in only the past few weeks during the local election campaign. I am not making this up, Madam Deputy Speaker. After the postal votes were opened and the Hammersmith Conservatives saw that we were ahead in some of their safe wards, the Prime Minister was brought down at short notice and locked in the basement of the Conservative party offices with a local journalist and came out with this pronouncement:
	“Charing Cross will retain its A&E and services”.
	I believe that the Prime Minister is an honourable man, and that he was misled into making that statement. The statement is demonstrably false because the NHS has
	clearly said that most of those services—other than treatment services, primary care services and elective surgery—will not exist at Charing Cross hospital under any analysis.
	I thus went to see Imperial. It was the day after the election and I had been up for 30 hours and was not in a terribly good mood. I went to see the new chief executive of Imperial, and I tried to persuade her that Charing Cross should stay open. I said that I would take the new Labour leader of Hammersmith council to see her, as he might be able to persuade her better than I could. I then left and went home. That evening, she e-mailed to say, “Oh, I forgot to tell you when you were here: we are closing the other A and E in your constituency on 10 September. It was just a short meeting and I did not have time to tell you about it.”
	At the same time, as my hon. Friend the Member for Westminster North said, the CCG is writing to tell us that it is good news that in year—in the middle of a financial year—it has decided to pull together £140 million from the CCGs around north-west London and to redistribute it into primary care. In other words, they are panicking and having to take desperate measures because the primary care services are so short of money and cannot pick up the slack from the closure of A and E services. We might think, “At least they are doing something”. A substantial proportion—they will not say how much—is going out of my CCG and into other CCGs because, they believe, that is a fair way to distribute money. We are losing not only both A and Es, but our primary care funding and, with the closure of Hammersmith A and E—if we cannot prevent it from going ahead in September—Imperial has admitted in its own board papers that there is insufficient capacity at St Mary’s hospital.

Lyn Brown: Has my hon. Friend conducted any analysis that could reveal whether the redistribution of funds among the CCGs will take money from the more deprived areas and give it to those that are better off?

Andy Slaughter: I thank my hon. Friend for that intervention. In exactly the same way, the Government are choosing to close the A and E department at Hammersmith hospital, which is slap bang in the middle of one of the most deprived areas of London, covering White City, Old Oak, Harlesden, north Kensington and east Acton. That means that 22,000 people who rely on those A and E services every year will have to travel to St Mary’s hospital in Paddington. They will not be directed to Central Middlesex hospital, which will be closing on the same day, and they will not be directed to Charing Cross hospital, because the plan is to close that within a year or two. They will be told to go to St Mary’s, where there are not enough beds and not enough capacity in A and E to cope with the current demand. That is contrary to undertakings given in the House that there would be no closures of A and E services until alternative services were provided. There will also not be enough acute services to provide a training base for students at Imperial college.
	Two weeks ago we won the election in Hammersmith, against the expectations of, at least, the Conservatives, and we won it on this issue. If the Government will not listen to the 100,000 people who petitioned, perhaps they will listen to the people of west London who, on
	the issue of the NHS, overwhelmingly voted Labour and against the policies that are being pursued by the Conservatives. They should listen, and they should think again about hospital closures that will cost the health and the lives of my constituents.

Mike Kane: I am delighted to be called tonight. As a by-election winner just 16 weeks ago, I felt the pressure of being 650th in the order of seniority, but, following the Newark by-election, I am now 649th.
	This was my first Gracious Speech, and I am prompted to echo the words of my hon. Friend the Member for Ilford South (Mike Gapes). I was born and raised in Manchester, 95 of whose 96 councillors are now Labour, while the 96th is Independent Labour. That reflects people’s serious concerns about health, the establishment of Healthier Together in Greater Manchester, and what has happened to Wythenshawe hospital’s accident and emergency services over the past few years.
	I pay tribute to the Leader of the Opposition and the Prime Minister for their kind words about Paul Goggins. He was an extraordinarily dedicated public servant, and the Prime Minister was very gracious in dedicating the legislation on child neglect to his memory. My constituents and I are grateful for that, and I know that Paul’s family will be as well.
	It often occurs to me that the NHS will really be 90 years old next year. Aneurin Bevan’s father died in his arms, of pneumoconiosis, without the benefit of any health care provision. Bevan felt that the pain of one was the pain of millions, and he decided on that day that he would build the extraordinarily fantastic service that became the NHS, which he created years later in 1948.
	I thought about why the Conservative-Liberal Democrat coalition partners did not want health to feature in this year’s Queen’s Speech in terms of electoral strategy, which was probably wrong. The key to any electoral strategy is not about two competing answers to the question, but about who gets to frame the question in the first place. The coalition partners want to ignore the health service because they know from Aneurin Bevan’s legacy, from the fact that we are leading in the polls, and from the way in which my right hon. Friend Member for Leigh (Andy Burnham) pounds the Government on these issues day in, day out in every part of the country that it is ground that Lynton Crosby wants them to avoid.
	The top-down reorganisation cost £3 billion, and what has it done for my constituency? The Government downgraded the A and E centre at Trafford general hospital, the first NHS hospital to be opened by Bevan in 1948. They shut the Wythenshawe walk-in centre, and there was then a crisis of pressure in Wythenshawe hospital’s A and E department. Fourteen weeks ago, I asked the Secretary of State to meet me to talk about that. I later sent him a personal note, but he has still not contacted me about such a meeting. His own MPs want to be involved in that meeting. MPs on all sides of the political divide want to sort that out. I am demanding that the Government meet local MPs to discuss the continuing pressures at the hospital. Those pressures are expounded day in, day out by surgery work.
	Last year, my constituent Emma Latham lost her husband Steven, aged 43. They had to wait 40 minutes for an ambulance. In February this year, she experienced breathing difficulties. The call was categorised as a red 2, but she still had to wait 40 minutes for the ambulance service to arrive. Tony Gunning, another constituent of mine, who has liver and heart failure, waited over an hour for his ambulance and for dialysis. He is often bundled into a taxi home by Arriva, the private sector provider, when it can organise one for him. John Ireland, another constituent of mine, has a heart condition. He has been told it will be two weeks before he can see his local GP.
	That is not good enough. The Government might not want this to be the agenda in the next 12 months but Labour Members will highlight every case, every hospital, every downgrade and every closure, and we will make the case clear to the British public next May. The NHS will last as long as there are folk to fight for it. We on the Labour Benches will fight for it.

Stephen McCabe: It is great to address the packed Benches on the Government side of the Chamber. This Queen’s Speech ought to be remembered as the last Queen’s Speech of the first coalition Government since 1945. I confess I am one of those who thought that it might never happen, but to their credit the coalition Government have put aside their differences and come up with a plan for a Bill to levy a 5p charge on poly bags. That would normally earn them a place in history, but this Queen’s Speech has been overshadowed, as we saw again today, by the row between the Home Secretary and the Education Secretary. Since the theme of today’s debate is health, let me say to the Education Secretary that trying to humiliate that lady could be very bad for his health—ask the Police Federation! Perhaps he should try to recruit a retired counter-terrorism officer to mind his back.
	This has always been a Government built on hype. It has been there from the beginning, when they claimed that trebling tuition fees and slashing public spending were all for our benefit and would eliminate the deficit within five years. That much heralded and rebranded long-term economic plan aims to cut the deficit by the same amount as my right hon. Friend the Member for Edinburgh South West (Mr Darling) would have achieved. What has become long term is the prospect of continuing cuts and a deficit stretching years into the future.
	We were led to expect a Bill to regulate health and social care professionals, but that is absent, despite Winterbourne, the Francis report and the latest Anglia Retirement Homes scandal. I regret that, because there is little doubt that we need to regulate those professions and provide greater assurance and security to patients, residents and relatives. I want to be able to tell my constituent whose elderly relative was induced to give a loan of several thousand pounds to her carer to buy a car that something will be done and that such crooks will not get away with it. I want to be able to tell the family of Ms Jones that, if they see the call button by the bedside disabled or find their elderly relative naked from the waist down and covered in excrement, something will be done. I want to know that the people who are doing the caring have been properly vetted and have
	suitable qualifications and training, are supervised and will be given the time to provide the care that their patients need.
	Of course I would have liked an admission that section 75 of the Health and Social Care Act 2012 was a disaster. Far from putting GPs at the heart of decision making, it has reduced clinical commissioning staff to second-rate auctioneers. At a time when Simon Stevens is calling for more local and community services to provide care for the elderly, section 75 requires doctors to act like second-hand car salesmen. The way forward is to construct models that bring together statutory and voluntary services. We need the local state working alongside bodies like churches, community groups and even neighbours. Clinical commissioning groups should be creative and imaginative; instead they are stymied by the Government’s market dogma.
	As this is carers week, I would have welcomed a law that recognised the rights and needs of the users of health and care services, that empowered them so that joint commissioning bodies were not allowed to close respite care facilities because accountants advised them it was an easy saving. I am battling to protect the Kingswood bungalows in my constituency, a purpose-built facility less than 15 years old, but targeted by those whose priority is to manage the books, not the interests of patients; and my constituent with severe autism who has lived in a specialist autism community for over 17 years. It is his home, but just as we have seen the crass contempt for people’s needs with the bedroom tax, we are seeing people like him threatened with eviction because the accountants and the joint commissioning administrators think they have found a way to save a few quid. I would have liked some legislation to regulate and enforce action against those who look after their own interests while wrecking the lives of others.
	I welcome the promise to raise the number of apprenticeships, because if there is one issue that threatens the health and well-being of a generation, it is the spectre of unemployment and the denial of a future for our young people, but how many will be real apprenticeships targeted on the 16-to-19 age range? As with every other bit of hype, too many of the current apprenticeships go to those over 25 and are often just an existing job that has been redesignated. This is, after all, the Government who think they can send a young graduate already engaged in productive voluntary work to Poundland to learn how to stack shelves.
	A Bill promising proper training, relevant qualifications, a chance to build a portfolio of skills, real employment opportunities and the full engagement of employers: that is what young people need. If we are living in the age of micro-businesses, and self and portfolio employment, then let us give young people the training that allows them to make a go of these things, rather than leaving them to be ripped off and exploited.
	Sadly, this is a Queen’s Speech with none of those relevant interests served.

Tom Blenkinsop: Over the space of a few weeks from this April, my constituency has been overwhelmed by a
	perfect storm of cuts and closures pushed through by NHS England and the local clinical commissioning group, all the result of this Government’s agenda.
	People in the rural East Cleveland part of my constituency need NHS services and support seven days a week, and that is why the last Labour Government proudly introduced NHS Direct and walk-in centres, but East Cleveland now faces a triple whammy. The South Tees clinical commissioning group wants to end minor injuries provision at East Cleveland hospital and Guisborough hospital. It has also decided to cease walk-in provision at Skelton medical centre at the end of June, while NHS England wants to abolish GP provision at Skelton medical centre.
	Ending minor injuries provision does not, in the words of the CCG consultation letter, provide
	“better care for the vulnerable and elderly”,
	and I fear that the CCG is trying to disguise cuts to vital minor injury provision. This leaves no urgent care services in East Cleveland.
	That is particularly problematic for the villages of East Cleveland, where public transport links are poor and an ambulance service provided by the North East Ambulance Service trust “cannot cope”, as its chief executive admitted. Over six months last year, the North East Ambulance Service recorded 10,599 delays, 196 of which were for more than two hours. Paramedics are left unable to respond to waiting 999 calls, and a regional BBC programme only last week showed that the situation is worsening. I have raised this matter in the House on many occasions.
	Both the two small hospitals I cited were once run by the local primary care trust, but after the coalition NHS reforms were pushed through they were passed on to the main hospital trust for our area, the South Tees Hospitals NHS Foundation Trust, which runs the excellent James Cook university hospital in Middlesbrough. The trust is already facing a £30 million to £50 million black hole in financing, having had only a £5 million deficit last year; it is being investigated by Monitor and has to make drastic cuts. It is little wonder that what might be seen as easy targets in ancillary units such as these two small local hospitals come up on the trust’s radar.
	In addition, we have had the CCG and NHS England turning their big guns on another NHS facility in East Cleveland: they are looking at, and have announced as a fait accompli, the total closure of the Skelton health centre and medical walk-in centre. That proposal is part of a national coalition approach that has been targeting walk-in clinics set up by the last Labour Government. If the closure goes ahead, Skelton will lose one of its GP practices, a nurse practitioner clinic and the attached pharmacy. The clinic serves people from the poorer areas of the ward such as Hollybush, the Courts and north Skelton.
	Like local people, I feel that NHS England is basing its views on old numbers which we feel are suspect. The provider, LivingCare, which owns the practice, is gobsmacked, as closure letters to people on the surgery list went out before they were told about the possibility of closure. In certain instances not enough letters were sent to people actually registered with the GP practice. Skelton as a town is undergoing vast expansion, with new housing going up and more planned. More than 1,000 new homes have been built in the past three years, with the new local plan indicating a further 400 homes on open land to the east of that new estate.
	LivingCare was hit by a further blow when NHS England then announced the imminent closure of another GP facility it runs in my constituency. Unlike the earlier closures, this was not in rural East Cleveland, but in deep urban south Middlesbrough, on the Park End estate. I know the area well as my mother was for many years a teacher at the St Pius X Roman Catholic primary school on the estate, and I have relatives who still live there. The estate has profound social needs, with associated poverty and high indices of ill health. The cuts occurring locally in my constituency will increase the likelihood of people going to A and E, even when that is not appropriate. Our A and E has struggled to cope with demand over recent years, so these cuts are a false economy.
	The mess of the Tory-Lib Dem NHS reorganisation, and the human tragedy it brings in its wake, deepens by the day. The coalition has already wasted £3 billion on a reorganisation and £1.4 billion on redundancies, and it is leaving the NHS weakened and confused. Locally, through this consultation, we are beginning to see the consequences on our constituents’ doorsteps. The approach being taken flies in the face of the call by NHS England’s new chief, Simon Stevens, for a marked change in policy and a shift away from big centralised hospitals. The health service chief executive says that we need new models of care built around smaller local hospitals and that, combined with comprehensive walk-in and GP care, is what my constituents need, deserve and rightly demand.
	I have not been idle on these issues, but all my efforts have been stymied by a combination of bureaucratic blocking and ministerial indifference, resulting in Ministers’ responding to my requests for meetings with refusals, despite earlier friendly patter. Despite an outcry from local people, a full-page protest poster in the local newspaper Coastal View & Moor News and a massive petition, I managed to organise a meeting with NHS authorities that was unhelpful to say the least. Instead of a commitment to examine the clinical arguments and the issue of closures putting more pressure on the A and E unit at James Cook university hospital—a hospital with one of the longest waiting times for A and E in the region, if not the country—the NHS reps at the meeting retreated behind the protection of contractual timetabling, based on funding cuts issued by the Department of Health, because the “Darzi clinics”, as they were at the time, are coming to the end of their five-year contracts. I can say now, without equivocation, that such an approach will inflame my constituents, as I have seen already on the doorstep.
	I still want to offer Ministers the option to meet me to talk about this issue, because I really fear the consequences for East Cleveland, and for Park End in particular, of these services being taken away. There is absolutely nothing in the consultation offering the individuals there any other option. There is no plan to put people in other GP practices. My fear is that we will have a time lag, and about 2,000 to 4,000 people not knowing where to go for primary care and ultimately ending up in the A and E unit—again.

Geraint Davies: The first line of the Queen’s Speech said that the long-term plan was to deliver a strong economy and a fair society. Failure to deliver in that regard is contributing to aggregate
	health costs in Britain. The question is how we use the existing budget to deliver better health, as opposed to increasing the aggregate amount of money that we spend on health to the levels that are enjoyed in the European Union and the United States. The answer must be to reduce some of the drivers of health costs and the conditions that are causing those costs in the health service.
	Obviously, the first driver is smoking. The Government have an opportunity to change packaging, stop children smoking in cars and accelerate the rate of transfer to e-cigarettes. There could be great savings there. At the moment, it costs us £5 billion a year to treat people for smoking-related diseases.
	The second driver is obesity. The Forsyth report suggests that, by 2050, half the UK population will be obese. There are issues about school meals and exercise. There is an option—I do not know whether the Minister is interested in this because he is looking at his iPad—to put a 20% tax on sugary drinks, which is seen in New York, Mexico, France and Norway. Oxford university thinks that such a measure would reduce the numbers of obese people by 180,000 and of overweight people by 285,000, and generate about £250 million of revenue, which could be hypothecated to fund cheaper fruit and vegetables for poorer communities.
	The reality is that only 10% of young people under the age of 18 consume their five fruit and vegetables a day, but children under the age of 10 are consuming 19 grams of sugar. There is a case for a sugar tax. Coca-Cola contains 11 spoonfuls of sugar, and there is 50% more sugar in sugary drinks than is advertised. We need to discriminate between certain ingredients, such as fructose versus glucose, because of their medical impact. It has been noted in American that fructose creates a different sort of fat cell in the liver and the heart, which causes much higher mortality rates. We need to focus in on the fact that there are different sorts of fat. Ironically, the EU, which I normally support, has suddenly agreed with the fructose lobbyists that fructose should be called healthier because the high from it is not as quick, but the damage is much greater. The same goes for palm oil, which is a big killer in America.
	Some of these issues are about taxing ingredients in processed foods. Madame Deputy Speaker, if I gave you a potato and told you to make some money out of it, you probably would not—or you might because you are a good person—just sell that potato. The way to make money out of the potato is to smash it up, add fat, salt and sugar, reform it as Dennis’s dinosaurs, put some packaging around it and a jingle on it and get children who are poor into the habit of consuming a large amount of it, so they die an early death. We should be aware of that, and we should be the guardians of the budget and of the people.
	The same is true of advertising. If one looks at the back of a cereal packet, it will say low fat, but what it means is 50% sugar, and sugar is fat. Sugar is converted to fat if it is not energised through exercise and the like. We should be here to protect people from that, but we have dismally failed to do so. In fact, the opposite has happened. The Government’s economic policies increase stress and poverty, which are drivers of poor health and cost.
	Britain now has the worst child mortality rates of the western world, bar Malta, with one in 200 children dying under the age of five. According to Washington
	university, that is linked to welfare cuts, which have driven people into using food banks. We just have to look at the situation on employment. We are told that there are all these jobs—I can see the Minister trying to ignore me—but 1 million of them are on zero-hours contracts. People are moving from benefits into zero-hours contracts, which leads to discontinuity in their benefits. They are having to go to food banks. They are under stress and feeling hungry, which leads to ill health for them and their children. Research suggests that 45% of people in debt have mental health problems—
	[Interruption.] 
	I can hear my hon. Friend the Member for Cardiff West (Kevin Brennan) listening to this. Research in the EU has shown that recession leads to suicide. Two thirds of people on whom the bedroom tax has been cruelly inflicted are disabled.
	The Government are responsible for many of the costs, which will become intergenerational, long lasting and profound. That is part of a process of saying that the health service is too expensive for the poor, so we should privatise it. Aneurin Bevan famously said:
	“Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.”
	I should like to see a future in which that community is one nation—not the weakest crushed by the strongest—so that that cost is shared more evenly and is lower and Britain is healthier for it. We look forward to a more equal Britain in opportunity and outcome, where the health of the nation is better and the salvation of the health service is once more in our hands, with a Labour Britain next year.

Emma Lewell-Buck: Our national health service is undisputedly one of the greatest achievements of any Government, yet the crisis that the NHS has experienced under the Government’s disastrous privatisation, threatens the survival of services and the quality of patient care. I am proud that it was a Labour Government who created the NHS, and I am proud it is a Labour Government who will reverse the damage done by the Health and Social Care Act 2012. In our health service, more than 4,000 senior nursing posts have been lost since 2010. Accident and emergency performances in the year following the Government’s reorganisation were the worst in a decade. Last year, South Tyneside hospital in my constituency had to cancel operations because of unprecedented demand for A and E services. Only two weeks ago, it emerged that the NHS in England had failed to meet a performance target for cancer waiting times for the first time ever.
	The Government’s failed reorganisation has increased wasteful spending. The NHS now spends more on senior managers and management consultants than ever before, and it is increasingly bogged down in competition law, forcing it to spend money on lawyers that could have gone towards patient care. The pressures on our health service stretch well beyond hospital waiting rooms, as demand for NHS services is affected by trends in public health and the quality of social care. In those areas, we have seen massive cuts to local authority budgets of £2.7 billion. Faced with cuts of that scale, local authorities have been left with impossible decisions
	and have been forced to cut services, knowing that in doing so they would increase pressure on the health service.
	Those who are lucky enough to be entitled to care find that their care worker can only stay with them for 15 minutes. These workers are poorly paid, with over 300,000 on zero-hours contracts. A third do not receive proper training. Unsurprisingly, staff turnover is high, so many clients do not manage to build a relationship with their carer. The Care Act 2014, which was passed in the last Session, presented an opportunity to address some of those issues, but unfortunately it was an opportunity that the coalition parties did not take. They rejected Labour amendments on low pay and zero-hours contracts that would have improved the standard of care that people receive. They also ignored charities that warned that the new eligibility criteria for support would exclude hundreds of thousands of people from the care system.
	Of course, there are challenges facing social care, but we do not solve the problem by cutting support for those with moderate needs, only for them to end up in hospital. Last year’s QualityWatch report showed that about one in five hospital admissions could be prevented by better social care. The ultimate goal should be an integrated system like the one argued for by my right hon. Friend the Member for Leigh (Andy Burnham). The Government at least pay lip service to that idea, but in practical terms they have done very little. The better care fund announced last June was meant for that purpose, but it was actually just money diverted from existing NHS services, proving that the Government are not serious about promoting integration.
	Underlying all of that are broader questions about public health. Poverty and ill health often go hand in hand, and malnutrition in particular has become a frighteningly normal part of life in Britain today. I know parents who skip meals so that their children can eat, and people for whom food banks are the only thing standing between them and starvation. Malnutrition affects an estimated 3 million people in the UK, which is a scandal in the fourth richest country in the world.
	The previous Government left office with fewer people in poverty than when they arrived. Child and pensioner poverty fell even after the financial crisis took hold, and we were well on our way to eliminating child poverty by 2020. But under the coalition, this trend has been reversed, and instead of eliminating poverty by the end of this decade the Child Poverty Action Group estimates that the number in poverty will have risen to 4.7 million.
	The coalition has allowed this crisis to develop, and the Queen’s Speech needed to recognise families’ desperation by delivering help with living costs such as food, energy and rent. Poverty, and food poverty especially, has a knock-on effect for our health system. Experts have warned that there is a public health emergency. We are beginning to see diseases such as rickets returning as children no longer receive the balanced diet they need. The symptoms of poverty pose serious challenges to our health service in the long term.
	Our national health service survives in spite of this Government, not because of them. It is strong because of its work force and because of a public who resolutely believe in it and value it. In communities around the country, families are fed not because their country’s Government have helped them to find decent work, but
	because their fellow citizens give up their time to lend a helping hand. Our country faces some of its biggest challenges for generations, and people feel that Britain is no longer working for them. Worse yet, people feel that politics has no answers to the difficult questions of our time. All these challenges need a Government who are willing to be bold, but this Queen’s Speech gave no hope of that. It was more of the same from a coalition that has long outstayed its welcome.

Eleanor Laing: And the prize for patience goes to Nic Dakin.

Nicholas Dakin: Thank you, Madam Deputy Speaker. It is a pleasure to speak in this debate.
	There is unanimity across the House on the importance of the NHS in our lives and the lives of the people we serve. The vast majority of people working in the HNS do fantastic work day in, day out, often in difficult conditions, to deliver a health service that is the envy of most parts of the world. In our desire to make that even better, we sometimes forget the very good things that are there, but when the NHS fails us, it is important that we tackle those failures effectively.
	One thing I have noticed when talking to health professionals at whatever level in my constituency in Scunthorpe is that they, to a man and a woman, feel that the reorganisation that was thrust upon them by this Government after promising no top-down reorganisation has distracted attention and added work load, when there is already a challenging work load to tackle without having to deal with that. There is a big enough challenge anyway.
	“Healthy Lives, Healthy Futures” is the consultation that North Lincolnshire clinical commissioning group is undertaking to find out whether to take forward health provision locally. That is an important endeavour, but the growth in the number of people turning up at A and E and the ageing population create great challenges for everyone. It is interesting that the financial challenges that are faced compound that. The PCT legacy debts were provided for and CCGs had further money taken out of their budget for that. A further £2 million was taken out of the CCG budget locally, although its budget is about £100 million, to deal with the pressures in specialist commissioning. The challenges involved in specialist commissioning need to be tackled. That might have been included in the Queen’s Speech.
	One of the oddities of the Queen’s Speech is how little there is in it about the thing that are most important to us—nothing about standard cigarette packaging, despite the Minister saying that she would introduce regulations, nothing on smoking in cars, despite the Minister saying that she would introduce regulations, and nothing to make it easier for people to see their GP. In its consultation with local people, Healthwatch North Lincolnshire identified access to a GP as one of the big issues locally. I had hoped that something would be done on that. I am pleased that the shadow Health Secretary made it very clear that Labour will at the first opportunity repeal the Health and Social Care Act 2012 and by rolling back the costs of competition and marketisation will guarantee an appointment at the GP’s surgery within 48 hours. That is something to be proud of.
	Another missed opportunity was to do something to end the abuse of older people. Why not respond to Age UK’s call to make it an offence to neglect a vulnerable adult and to ensure that directors of organisations that provide health or care services can be held accountable for neglect or abuse? Why not do something about that? There is so much that could be in this Queen’s Speech and is not but, as my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) said, at least we have the 5p plastic bag Bill and we should be grateful for that.
	Let me turn to another issue that could have been tackled in the Queen’s speech: the need to up the game on our work on antimicrobial resistance. Take for example tuberculosis, caused by bacterial infection through the air. If left untreated, it becomes deadly and BCG vaccinations are not as effective as they should be. Many people think that TB has been wiped out, yet London has the highest rate of TB of any capital in the western world. An increasing percentage of those cases are resistant to TB drugs and TB has always affected the poor. No new front-line drugs have been developed in 50 years, so why not tackle this disease, which is a real threat and is already here?
	TB can be prevented by relatively low levels of investment in proactive diagnosis, outreach and good social and clinical care. It is a complex disease that can be made more complex by our health services, which often fail to diagnose it on first sight. Some doctors unfortunately prescribe antibiotics, which feed the AMR and do nothing to help patients with TB. We need to raise awareness of the disease and make sure that patients get the right support from health services that are properly staffed and equipped. We need comprehensive outreach for TB, with screening, diagnosis and treatment of people before their health deteriorates and before they can pass the disease on to others. In short, we need a preventive approach to TB and other infectious diseases like it.
	We need to invest now to save later, and my point about TB is illustrative of the many other things on which we need action. Instead of that action, in this Queen’s Speech we have more of the same inaction and inertia. It is not good enough. I mark this Queen’s Speech low on its approach to health issues, and I look forward to hearing the responses from the shadow Minister and the Minister.

Liz Kendall: We have had a wide-ranging debate. I listened carefully to the powerful speech by the right hon. Member for North Somerset (Dr Fox)—I am sorry he is not in his place—on his concerns about Russia, which I share, and to the thoughtful contribution made by my right hon. Friend the Member for Neath (Mr Hain) about the Government’s pension reforms. I for one am sorry that this will be his last contribution in a Queen’s Speech debate and he will be sorely missed by Members on both sides of the House.
	The main focus of the debate has been the NHS and social care. My right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) and my hon. Friends the Members for Mitcham and Morden (Siobhain McDonagh), for Ilford South (Mike Gapes), for Hammersmith (Mr Slaughter), for Wythenshawe and Sale East (Mike Kane) and for Middlesbrough South
	and East Cleveland (Tom Blenkinsop) spoke passionately about their local services and the pressures they face. Those pressures are being experienced by services across the country as our population ages and more people are living with long-term conditions and the biggest challenge facing us is to reform front-line services to get better results for patients and better value for taxpayers’ money when there is far less money around.
	Some services must be provided in specialist centres so that patients get expert treatment 24/7, but there must be a fundamental shift in other services out of hospitals into the community, focused on prevention and joined up with social care so that people can stay healthy and living independently at home. The last Labour Government had plans to deliver these changes in every English region through Lord Darzi’s NHS next stage review, and the single biggest mistake by this Government on the NHS was to scrap those plans and instead waste three years and £3 billion on the biggest backroom reorganisation in the history of the NHS.
	Ministers do not want to talk about their reorganisation and their failure to make the real reforms that patients will need in the future. The Queen’s Speech should have included a Bill to modernise the regulation of doctors and nurses, in order to improve the safety and quality of care. That was recommended in the Francis report, it is what the General Medical Council and the Nursing and Midwifery Council want, and it is what patients desperately need, but Ministers have failed to deliver. They are desperate to avoid another NHS Bill after their disastrous Health and Social Care Act 2012, especially in the year before a general election, but let me remind hon. Members of the mess made by that Act.
	Ministers said they would cut bureaucracy, but instead they created 440 new organisations: NHS England; Public Health England; Health Education England; four regional NHS England teams; 27 local area teams; 19 specialist commissioning units; 221 clinical commissioning groups; and 152 health and wellbeing boards. It is a system so confusing and dysfunctional that no one knows who is responsible or accountable for leading the changes that patients want and taxpayers need to ensure that the NHS is fit for the future.
	Ministers promised that their reorganisation would save money, but £1.4 billion has been spent on redundancy payments alone and more than 4,000 people who were made redundant have now been rehired somewhere else in the system. And as if this chaos and confusion was not bad enough, the new chief executive of NHS England says there has got to be yet more change, with yet another reorganisation of specialist commissioning, because costs have spiralled out of control, and a reorganisation of NHS England’s regional and local area teams. As my right hon. Friend the Member for Leigh (Andy Burnham), the shadow Health Secretary, said, this truly is the reorganisation that never ends.
	The real cost of the Government’s failure on the NHS does not stop with their reorganisations. Labour Members warned that handing responsibility for local GPs to a national quango such as NHS England, scrapping the 48-hour waiting target and removing Labour’s incentives for evening and weekend appointments would mean GP services going backwards and, as my hon. Friends the Members for West Ham (Lyn Brown)
	and for Scunthorpe (Nic Dakin) said, that is exactly what has happened. A quarter of all patients now say they cannot get a GP appointment in the same week, let alone on the same day. We warned that cancer care would go backwards when the Government abolished vital cancer networks, and that is exactly what has happened. Two weeks ago, the NHS missed the cancer waiting time target—the first time any cancer target has been missed since 2009. We warned that disproportionate cuts to mental health services would mean worse care for patients and extra costs elsewhere in the system, and that is exactly what has happened. Patients are being sent hundreds of miles away because there are not enough beds locally, causing them and their families terrible distress and costing taxpayers millions of pounds extra.
	We warned that slashing council care budgets was a false economy that would mean fewer elderly and disabled people receiving the support they need, forcing them into hospital and piling pressure on families and local A and E units. As my hon. Friends the Members for Worsley and Eccles South (Barbara Keeley), for South Shields (Mrs Lewell-Buck) and for Westminster North (Ms Buck), as well as the hon. Member for Newton Abbot (Anne Marie Morris), rightly said, that is exactly what has happened. Fewer elderly people are getting vital help, such as home care visits or support from district nurses, so more of them are ending up in hospital and getting stuck there for longer.
	We have had the worst year in A and E for a decade, with a million people waiting for more than four hours. Delayed discharges are at their highest ever for this time of year. These delays cost £268 million last year, which could have paid for 20 million hours of home care. Where is the sense in that?
	Rising emergency admissions mean planned operations are going backwards too. Three million people are now on hospital waiting lists, which is up by half a million people since 2010. Last year, 64,000 operations were cancelled—the highest figure in a decade.
	The combined effect of the Government’s disastrous reorganisation and their incompetent decisions means that Ministers have lost a grip of NHS finances too. This year, trusts are in deficit for the first time in seven years, and twice as many foundation trusts will be in deficit compared with last year. The NHS trust deficit will be three times higher than they predicted even at the beginning of this year. The real tragedy is that all that could have been avoided if Conservative Ministers had not been blinded by politics and ideology and if Liberal Democrat MPs had had the guts to oppose them.
	The truth is that there was nothing on the NHS in the Queen’s Speech because the coalition Government have no plan and no idea how to solve the problems they have created. In contrast, a Labour Queen’s Speech would repeal the Health and Social Care Act so that services can work together in the best interests of patients and get the best value for taxpayers’ money. A Labour Queen’s Speech would use savings from scrapping the costs of competition to guarantee new rights for patients to see their GP at a time that is convenient for them. A Labour Queen’s Speech would end the scandal of inappropriate 15-minute home care visits and exploitative zero-hours contracts so that elderly and disabled people get the quality of care they deserve.
	A Labour Queen’s Speech would deliver the real reforms that patients and their families need to create one health and care system and ensure truly personalised care: integration, not fragmentation; wise expenditure, not waste; putting people first, not playing politics with their health and the services families rely one. That is what patients want, what taxpayers need and what our constituents deserve, and that is what a Labour Government will deliver.

Norman Lamb: I thank all right hon. and hon. Members who have contributed to today’s debate. It has been a wide-ranging debate stretching well beyond the NHS, as the shadow Minister said. I think that we all enjoyed the alternative Queen’s Speech from the hon. Member for Blyth Valley (Mr Campbell). His Front Bench colleagues looked horrified, but it was the authentic voice of Labour.

Ronnie Campbell: There were some good policies in there.

Norman Lamb: Well, let us just make sure that Opposition Front Benchers listen to the hon. Gentleman.
	We can be justifiably proud, it seems to me, of the action we have taken in health and care over the course of this Parliament. The hon. Member for Scunthorpe (Nic Dakin) made a speech that faded away from agreement, but at the very start he made the point that we should all pay tribute to a really remarkable work force in the NHS—1.3 million people doing incredible work. We want to free those people up as much as possible to do the very best they can.

Andy Burnham: Would not the best way to pay tribute to those thousands of staff in the NHS be to honour the 1% pay increase that the Chancellor promised them?

Norman Lamb: That is equivalent to about 6,000 nurses a year. The right hon. Gentleman has to demonstrate how that would be paid for. The fact is that there is an average wage increase of 3% as a result of annual pay increments under Agenda for Change. We have ensured that at least everyone will get a 1% increase. If he is arguing for something different, he has to say where the money would come from to pay for it and how he would cope with 6,000 fewer nurses, which would be the result of his action.
	For the first time, it is this Government who have made decisive moves to join up the care and health system and focus more on preventing ill health. Contrary to the shadow Secretary of State’s claims, the better care fund has been widely welcomed, and it has initiated action across the country to join up a very fragmented system. We have sent out the signal that we encourage innovation and change, driven by clinicians from the bottom up, not from the top down. Brilliant pioneers across the country are ending this fragmented system that has interrupted patient care for so long and failed patients. Those pioneers are combating loneliness, which my hon. Friend the Member for Burnley (Gordon Birtwistle) spoke passionately about. It is so far removed from the caricature offered by the shadow Secretary of State and the tired old refrain about privatisation. It
	was, after all, a Labour Government who mortgaged the future of the NHS to the tune of billions of pounds with their private finance initiative programme, giving massive windfall profits to private consortiums—a scandal of historic proportions. Yet Labour Members continue to argue that the Government are privatising —an argument that is based on thin air, not substance.

Tom Blenkinsop: Will the Minister tell the House at what point the provisions of the Competition Act 1998 were introduced into the Bill that became the Health and Social Care Act 2012? I think it was this Government who did that. In the Public Bill Committee, I commented on the fact that they were exposing the NHS and undermining the category B status of the European competition regulations by putting the Competition Act at the very heart of the Bill.

Norman Lamb: I am sorry to disappoint the hon. Gentleman, but it was under the Labour Government that it was made clear that competition law applied to the health care system. Indeed, the Labour Government’s guidelines on the NHS replicated exactly the regulations under section 75 of the Competition Act that this Government have introduced. Time and again, we hear false claims by Labour Members.
	This Government have developed a new health and care system that is totally patient-centred, led by health professionals, and focused on delivering world-class health outcomes. The difficult decisions that we have made on public finances have meant that we have been able to protect the NHS budget. The shadow Minister spoke as though the Government have had to face no financial challenge at all. She knows that across Europe, Governments have slashed pay for health workers and introduced co-payments. We have done none of that. We have protected the budget for the NHS, and we are proud of doing so; Labour did not commit to that in its manifesto at the last election. The truth is that the NHS is doing extremely well under a great deal of pressure.
	This Government have laid solid foundations to transform our NHS to help it to meet the challenges of an ageing population, drive up standards, and focus absolutely on compassionate care. My hon. Friend the Member for Mid Worcestershire (Sir Peter Luff) spoke movingly about his experience of the importance of compassionate care. We have introduced tough, robust inspections overseen by new chief inspectors of hospitals, of social care, and of general practice. We have introduced ratings of hospitals, care homes and GP practices so that people know how good their local services are. We have introduced, for the first time, fundamental standards and the ability to prosecute—to hold to account organisations and directors who seriously fail patients. We have introduced a fit and proper person test for directors; for the first time, compulsory training for health and care assistants; and—I am particularly proud of this—a statutory duty of candour to ensure that there is openness when things go wrong in the NHS or the care system.

Geraint Davies: Given the Minister’s focus on accountability and transparency, why will he not support the regulation of psychotherapists and counsellors? My private Member’s Bill would have protected 1 million people.
	He or I could set up shop as psychotherapists tomorrow and see these vulnerable people who are currently at risk. Why will he not protect them?

Norman Lamb: The Government are not convinced by the argument for statutory regulation. The hon. Gentleman and I have had this debate many times, and I am happy to continue to discuss the matter with him.
	In the wake of Francis, the Government are clear that poor or unsafe care will not be tolerated. There will be consequences for those who fail patients.
	Opposition Members have criticised the lack of health legislation in the Gracious Speech, yet, as several of my hon. Friends, including the Members for Witham (Priti Patel) and for Rochford and Southend East (James Duddridge), have noted, people are not out there on the streets demanding a new NHS Act of Parliament; they want safe, good, compassionate care.
	The Government remain committed to legislating on professional regulation when parliamentary time allows.

Jamie Reed: Will the Minister give way?

Norman Lamb: Let me complete this point.
	This is a complex area and we should not rush to legislate. We will keep making progress to respond to the scandal of Mid Staffordshire for the remainder of this Parliament. We are working closely with the regulators to ensure that key provisions, such as a faster fitness to practise test for nurses and midwives and English-language checks for all health care professionals, are in place during this Parliament.
	The shadow Secretary of State quoted selected statistics on access to a GP, yet 86% of patients are satisfied with their GP practice. The Government have introduced a £50 million challenge fund, which will support more than 1,000 practices to develop innovative and flexible services. That will include Skype and e-mail consultations, as well as extended hours, and will benefit more than 7 million people.
	The right hon. Member for Cynon Valley (Ann Clwyd) again spoke extraordinarily passionately, giving a voice to those who feel they have no voice in our system. We should all express our gratitude to her for her continued campaigning on this critical issue, which demonstrates that we still have a long way to go if we are to ensure that we have a system of which we can all be genuinely proud. Like the right hon. Lady, I hope that one day the flood of letters on poor care will stop. We are doing what we can through the actions we are taking and we are grateful to her for the enormously valuable work she did on the complaints system. I hope the Labour Administration in Wales will do the same, especially after she eloquently highlighted the problems there in a recent BBC documentary.

Barbara Keeley: Will the Minister give way?

Norman Lamb: I have given way quite a lot; I need to make some progress.
	The right hon. Member for Newcastle upon Tyne East (Mr Brown) asked about allocations. It is right that
	the allocation of funding is no longer a political football but in the hands of experts. NHS England is seeking to make progress on reducing inequalities.
	The hon. Member for Blyth Valley (Mr Campbell) talked about charging in the NHS. Access to NHS services is based on clinical need, not on an individual’s ability to pay. That is fundamental to the NHS, and for as long as this coalition Government are in power the NHS will remain free.
	We heard from Members on both sides of the House —my hon. Friend the Member for Bracknell (Dr Lee) and the hon. Member for Westminster North (Ms Buck)—that health care needs to change so that care is provided more locally. The better care fund establishes a £3.8 billion pooled fund, to help people to stay healthy and independent.

Barbara Keeley: It is not new money.

Norman Lamb: Of course it is not new money—this is a different way of working. We have never claimed that it is new money; this is to ensure that we use the money more effectively. Indeed, the hon. Lady’s Front-Bench colleagues have made the argument that by pooling the health and social care budgets, we can achieve more with the money available.

Barbara Keeley: Will the Minister give way?

Norman Lamb: No, I will not; I have given way many times. The fund is the largest financial incentive by any Government to promote integrated care, and it would be better if Opposition Members applauded the initiative rather than constantly criticising it.
	At the start of this Parliament, this Government had five priorities for health and social care. We have delivered on all of them. Through the Care Act 2014, we have delivered the most profound change to the care and support system for a generation. After a decade of inaction under the previous Labour Government, we have introduced, for the first time, a cap on care costs and extended means-tested support. No one will have to sell their home during their lifetime to pay for care.
	Under the leadership of Public Health England, we have created a new public health service, giving public health the priority it deserves in local government alongside other local services. As my hon. Friend the Member for Newbury (Richard Benyon) outlined, it is vital that we prevent ill health in the first place, as opposed to repairing the damage once it is done.
	We are transforming health and care so that services are integrated around the needs of patients and users. We have revolutionised NHS accountability and seen a successful transition to a new health and care system. Finally, by focusing on outcomes rather than top-down diktat, we can identify what works and where we need to give additional support to help the system do more.

Jamie Reed: I always enjoy the hon. Gentleman’s emollient Dr Jekyll, in contrast to the Secretary of State’s Mr Hyde. Will he be following the Crosby diktat and keeping his head down and his mouth shut about the Government’s record on the NHS between now and the general election, or will the Liberal Democrats be doing something rather different?

Norman Lamb: I am very happy to speak for myself, and I will do so in due course. I am sure that the Secretary of State is enormously grateful to the hon. Gentleman for his description of him.
	In the final session of this Parliament, the Government will continue to ensure that the new health and care system works with both integrity and purpose, delivering safe and compassionate care to patients, their families and friends.
	Ordered, That the debate be now adjourned.— (Mr Gyimah.)
	Debate to be resumed tomorrow.

Undeclared Work (Reasoned Opinion)

[Relevant document: Forty-ninth Report from the European Scrutiny Committee, Session 2013-14, on Undeclared Work: Reasoned Opinion, HC 83-xliv.]

Jennifer Willott: I beg to move,
	That this House considers that the draft Decision on establishing a European Platform to enhance cooperation in the prevention and deterrence of undeclared work (European Union Document No. 9008/14 and Addenda 1 and 2) does not comply with the principle of subsidiarity for the reasons set out in the annex to Chapter One of the Forty-ninth Report of the European Scrutiny Committee (HC 83-xliv); and, in accordance with Article 6 of Protocol (No. 2) annexed to the EU Treaties on the application of the principles of subsidiarity and proportionality, instructs the Clerk of the House to forward this reasoned opinion to the Presidents of the European Institutions.
	This debate will give the House a welcome opportunity to discuss the proposed platform on undeclared work, and to decide whether to send a reasoned opinion to the European Commission. The Commission proposal seeks to establish an EU-level platform on undeclared work. Undeclared work is defined by the Commission as paid activities that are lawful but are not declared to public authorities. This matter is high on the European Commission’s agenda, against a backdrop of efforts to improve job creation, job quality and fiscal consolidation.
	The proposal highlights a number of concerns, based on a perception of high levels of undeclared work in the EU, including tax evasion, mis-declaration of hours worked and benefit fraud. The Commission is proposing a platform, whose members will be drawn from member states’ nominated enforcement bodies, to try to improve co-operation, share best practices and identify common principles for inspections. I should of course stress that addressing undeclared work is a priority for the Government. We have taken action at national level to detect and deter fraud through inspection, as well as to encourage good practice by providing guidance for employers.
	The debate has been called because the European Scrutiny Committee requested an opportunity to discuss its concerns about whether the proposal respects the principle of subsidiarity. There are also very short time scales and deadlines to which the European Commission is seeking to secure agreement on a position; hence the debate taking place tonight.
	Let me first turn to the issue of subsidiarity. The concerns that I set out in the explanatory memorandum—the Committee shares those concerns—were based on the initial draft of the proposal, which sought to mandate member states to participate both in the platform and in any enforcement activities arising from the platform’s recommendations. Like the Committee, we remain to be persuaded that the Commission has demonstrated a need to mandate member states to take part in the platform or that EU-level intervention action will add value.
	However, it emerged in negotiations late last week that although member states’ participation in the high-level platform would be mandatory, participation in any cross-border operational activities recommended by the platform would be voluntary. The Council’s legal service has indicated that that is the case, and we have asked it
	to clarify its official position. Therefore, the principal concern about subsidiarity that we identified in the explanatory memorandum—based on an earlier text—drops away. We could decide, issue by issue, whether the UK should participate in further activity, and we would of course seek the Committee’s views on such matters. However, we have not yet had advice from the Council’s legal service in writing, and the proposals are still being negotiated, so they may change. I therefore understand that the Committee will want to decide for itself whether the proposal respects the principle of subsidiarity.
	Our concerns about the detail of the proposal have been shared by other member states and, together, we have secured some changes. The changes, alongside the fact that the activities identified will not be mandatory, mean that the majority of member states will support the proposal. Therefore, the original subsidiarity risk that we identified does not still stand. Moreover, we should be involved in discussions about activities in relation to which we could be asked to take action, even if we probably do not want so to act. Negotiations are ongoing and the European Parliament is yet to begin its consideration of the proposals, so we will be continuing to work throughout the negotiations to ensure that our concerns about subsidiarity are addressed in the final text.
	Let me now turn to justice and home affairs. Since publishing the explanatory memorandum, our ongoing analysis has identified that the proposal may include elements relating to justice and home affairs, thus invoking the UK’s JHA opt-in. That is because the proposals suggest, for example, that enforcement bodies such as the police will collaborate in cross-border activity. No decision has yet been made on whether or not to opt in to the proposal. Once a decision has been made, we will write to the European Scrutiny Committee. Having said that, as it is not mandatory to participate in any activities that result from the discussions, no significant burden would be placed on the UK by opting in.
	The Commission and presidency are pushing hard on the proposal, and we were informed on Friday that they hope to reach a general approach on 11 June, which is very soon. The deadline for sending the reasoned opinion to the Commission is 11 pm tonight. With the timing of the recess and the Queen’s Speech, this evening was the earliest opportunity to facilitate a discussion in time to meet the deadline, although I appreciate that the timing is not ideal for such an important discussion. If we run out of time tonight, I will be happy to follow up any questions in writing, although given the numbers present, that seems somewhat unlikely—[Interruption.] The shadow Minister may want to raise lots of questions.

Ian Murray: indicated dissent.

Jennifer Willott: Oh, I am looking at the wrong side of the House. I hope that we will have time for a reasonable discussion and come to a decision on issuing a reasoned opinion tonight.

Ian Murray: I thank the European Scrutiny Committee for its consideration of this issue and the Minister for her comments. Given the
	time scale involved and the number who would like to speak, we should try to meet the European Commission’s 11 o’clock deadline, although I doubt that I share the Minister’s enthusiasm or optimism that we will do that, given the Members who wish to speak. Nevertheless, as the Minister said, we have the first opportunity for the House to start banging on about Europe again so soon in the new Session.
	It is worth reflecting on what is in the document, because undeclared work is an important issue. We should reflect on how harmful it can be to our economy and to the people who participate in it, and particularly on bogus self-employment in the construction sector. I was going to talk a little about that, but, given the time scale, I would like simply to agree with the Minister on the issues around subsidiarity and what the proposal is trying to achieve.
	We have no problem whatever with trying to improve co-operation between member states’ enforcement authorities in order to prevent and detect undeclared work, including bogus self-employment. We should all share that aim, and it is welcome for all member states to work together on that. We should also be improving member states’ enforcement authorities by giving them the technical capacity to tackle cross-border undeclared work. We are very good at that in this country and should be sharing our best practice, as well as getting best practice from other member states on other mechanisms for doing that.
	The third aim of the document is to increase public awareness of the urgency of action and to encourage member states to step up their efforts to deal with undeclared work across the European Union. I could spend a few minutes bashing the Lib Dem Minister and ask her what she is doing to persuade the Commission to look seriously at subsidiarity, because if they were to remove the mandatory element of the proposal, everyone would welcome taking it forward on a non-compulsory basis and be able to help other member states to go forward with the rest of the proposal.
	The reality on the ground is that people are often looking desperately for work and will sign any contract placed in front of them in order to secure employment. With the freedom of movement across the EU, it is right that member states work with one another to tackle rogue employers who perpetrate undeclared work and attempt to hide behind other member states’ borders—they hide behind undeclared work in order not to pay their fair share of taxation and to undermine workers’ rights. It is that sort of limited and practical proposal that shows how the European collaboration project could work and add value to member states.
	I do not know whether the Minister will get an opportunity to respond to the debate, or whether she will have time to do so, but I would like to pose a number of questions; if she does not get an opportunity to respond, perhaps she could write to me to give me some comfort.
	What assessment has the Minister’s Department made of the scale of undeclared work across the EU, and in particular the UK? What investigation has she made into the cross-border problems of undeclared work? That information may be incredibly helpful in indicating the problem we are dealing with and what the benefits of such an EU-wide platform would be. What recent discussions have current enforcement agencies such as the Gangmasters Licensing Authority, the Employment
	Agency Standards inspectorate, and Her Majesty’s Revenue and Customs had with the Government and the European Commission on undeclared work and the usefulness of the proposal? Finally, I do not think the Minister mentioned this, but does she agree with the proposals in principle? The Opposition agree with the Government’s position, and hope we can get it to the European Commission as soon as possible.

William Cash: We are extremely conscious of the timetable this evening, and the fact that the whole business must be dealt with by at least 10.45 pm. We will do our best—at least, some of us will—to ensure that we get through the business as quickly as possible, but we must also have regard to what needs to be said.
	The explanatory memorandum that the Minister has just discussed states:
	“The Government is not yet persuaded that the proposed decision to require Member States to participate on a mandatory basis is consistent with the principle of subsidiarity and believes that participation in any platform should be on a voluntary basis.”
	I know that further consideration is being given to that position, and as far as we are concerned the matter is of sufficient importance to be regarded as a breach of subsidiarity. That is our view, and the view of our legal adviser and the European Scrutiny Committee. The Minister added:
	“The Government’s view is that the proposal lacks the empirical evidence base or analysis of structural failure at Member State or Union level which would support a case for intervention.”
	We wish to underline the inadequacy of the Commission’s impact assessment, which acknowledges the absence of a clear “incidence chain” linking the establishment of the EU platform to a reduction in undeclared work, greater social well-being and better economic outcomes.
	We also seek a clear explanation from the Government about their position on the content of the draft reasoned opinion prepared by the European Scrutiny Committee, as well as an indication of how they intend to use it in Council negotiations on the draft decision. Will member states continue to express a preference for voluntary participation in any EU platform on undeclared work? The Commission’s impact assessment indicates that most member states favour a voluntary approach.
	We wish to press the Minister for a clearer indication of the scale and significance of the cross-border dimension in tackling undeclared work. In that context we bear in mind that, as she has said, there are justice and home affairs implications in respect of that and of whether there should be an opt-in. Will the Minister confirm that the Government will oppose any attempt in the general approach proposed to interfere in internal governance structures and the co-ordination mechanisms of national enforcement authorities responsible for tackling undeclared work?
	I think that that is as much as needs to be said at this stage, but I wanted to put that on the record and make a general comment about reasoned opinions. I have been sceptical about reasoned opinions and the yellow card system for a long time—in fact, from the moment they were first put forward. We know that there are thresholds, but we were extremely disturbed when, in relation to the European Public Prosecutor’s Office, the threshold was
	passed by all member states and—surprise, surprise—the European Commission ignored that fact. The national Parliaments, which the Commission keeps telling us are so important, took the view that there was a breach of subsidiarity. On account of that it was assumed that the Commission would withdraw the proposal, but no such thing occurred.
	I say that in general as we start the new parliamentary Session, because it is no good getting these grand statements—we are getting a lot at the moment—from the likes of Mr Juncker and company about the kind of European Union they want. There are very serious questions about the drive towards political union. If they want to trample on national Parliaments, when they put forward and achieve the threshold in terms of reasoned opinions and subsidiarity, and just ignore them, then I am afraid the increase in disaffection with the European Union will grow exponentially.

Chris Heaton-Harris: I shall be very brief, because I, too, know the time limits. I prepared a great oration to last for 90 minutes, because I know the Minister loves it so much. Really, I have just two questions: first on the detail of the Government’s position and secondly on the legal base.
	The first question is a fairly easy one. The Government were uncomfortable with the legal base put forward by the Commission in article 153(2)(a). I am not sure what the Government’s current position is and I would very much like to hear what the Minister has to say.
	Equally, I was not quite sure from what the Minister said whether the Government’s position on subsidiarity was shifting following the clarification at Council working group level that, while participation in the proposed EU platform will be mandatory for all member states, participation in the activities of the platform will be voluntary. I am not sure that that will be the case, because in the proposed text issued by the Commission it does not appear that the national authorities’ participation in the activities of the platform could, or would, be voluntary. Article 5(1) requires that
	“Each Member State shall appoint one single point of contact as a member of the Platform.”
	Article 5(4) provides that
	“Single points of contact shall liaise with all enforcement authorities which are involved in the prevention and/or deterrence of undeclared work regarding the activities of the Platform and guarantee their participation at the meetings and/or contribution to the activities of the Platform or its working groups if issues discussed involve their field of competence.”
	It strikes me that there is a bit of an issue here, which is one of the very good reasons why we should issue a reasoned opinion. I would like the Minister’s clarification on that.
	Finally, there is quite a budget attached to this platform. Europe is very good at spending money on doing these things. Personally, I do not see the value in half of this stuff, but I would very much appreciate it if the Minister clarified those two points.

Jennifer Willott: A number of the points that have been raised by hon. Members are very similar. First, it is important to put on the record that undeclared work
	is an extremely important issue across Europe. It is on a larger scale in some countries than others. The hon. Member for Edinburgh South (Ian Murray) asked what research had been undertaken on the levels of undeclared work in the UK. The most recent estimate for the UK was, I think, 1.7%—extremely low. In other member states the figure is significantly higher, so it is clearly a bigger issue in other states.
	Cross-border working was mentioned by the hon. Member for Stone (Mr Cash) and the hon. Member for Edinburgh South. One of our concerns is that very little evidence has been put forward on the implications and requirement to take action on cross-border work. On the assessment of the numbers and the amount of detriment that can be attributed to them, we are not convinced that the data are particularly accurate. We have asked the European Commission to identify, in a much better way, the scale of the problem. The UK, alongside other member states, does a lot of work internationally across borders, in a completely voluntary way, to try to tackle these issues. A huge amount of work is done because, as responsible Governments across different countries, we all think it is really important to tackle this issue. We do not feel that the Commission has provided evidence that what is being done at the moment is not a good enough approach and we have not seen evidence to suggest that the problem is significantly larger. That is one of the main reasons why we feel that the Commission has not made the case for why this needs to be done at EU level, rather than at member state level.
	The hon. Member for Stone asked about participation and about our position on the subsidiary principle, given that we are saying that the position has changed. We still have concerns that the mandatory nature of the platform is a breach of the subsidiarity principle. However, as regards the operation, given that the only mandatory element is attendance at the platform, we now believe that the concerns we raised in explanatory memorandums about the requirements for member states to take action when it is for them to decide—it has been agreed in the negotiations that it should not be mandatory—are not such a problem for the UK. Yet we feel it is really important that any activity should remain voluntary rather than mandatory.

William Cash: Is the Minister saying that she still believes that, as far as the UK Parliament is concerned, there should be a yellow card for the purpose? The question is as simple as that.

Jennifer Willott: We certainly support today’s motion, and we think that we should be sending a reasoned opinion. Our concerns are, however, less, now that the rest of it appears to be voluntary. We still feel strongly about the mandation, which is why we are working with other member states on the negotiation to ensure that the activity that follows from the platform should be voluntary. That is why we have asked for written confirmation from the Council legal services. We tried to get it for this evening’s debate so that we could be clear on the position. It is still a moveable feast and we are still in negotiations, but we hope to reach that position. A number of other member states have similar concerns about the mandatory element and we are not the only member state working to try to ensure that the rest remains voluntary.
	The hon. Member for Edinburgh South referred to the issue of bogus self-employment in the construction sector. We hope that the work of the platform will include looking at such issues and analysing them. We will press for a full analysis of areas that we think it would be useful for the platform to consider.
	The points raised by the hon. Member for Stone about the yellow card system generally are above my pay grade, but I think that his points were well made and I will make sure that they are referred back to the most appropriate Minister.
	I hope that I have tackled all the issues raised. If I have not—we can go through the Hansard—I will be more than happy to clarify anything I may have overlooked.
	Question put and agreed to.

Business without Debate

BUSINESS OF THE HOUSE (PRIVATE MEMBERS’ BILLS)

Ordered,
	That:
	(1) Private Members’ Bills shall have precedence over Government business on 5 and 12 September, 17 and 24 October, 7, 21 and 28 November, 5 December 2014 and 9, 16 and 23 January, 27 February and 6 March 2015; and
	(2) the resolution of the House of 2 December 2013 relating to Adjournment (February, Easter, May Day, Whitsun, Summer, Conference recess, November and Christmas) shall be amended by leaving out ‘Thursday 11 September 2014’ and inserting ‘Friday 12 September 2014.—(Mr Lansley.)

CHILDREN WITH EPILEPSY (CHILDREN AND FAMILIES ACT 2014)

Motion made, and Question proposed, That this House do now adjourn.—(Mr Gyimah.)

Paul Maynard: It is a pleasure to be able to initiate a debate on this issue. It is not the first time that we have discussed epilepsy in the Chamber, and I certainly hope it will not be the last. We had a useful Westminster Hall debate back in February 2013, initiated, I believe, by the hon. Member for Walsall South (Valerie Vaz), and I had a debate back in October 2010, which was my first on the topic.
	Rather than look at the wide spectrum of epilepsy today, I want to focus—laser-like if I may—on the issue of epilepsy in education and the implications of the Children and Families Act 2014, which has just been introduced and which I think represents a fork in the road for how we deal with pupils who have serious medical conditions such as epilepsy.
	Before I get into the nitty-gritty, it would be worth focusing once again on the numbers and the context. There are 122,000 children with epilepsy at any one time in our schools system—four times more than have diabetes. Diabetes has, quite rightly, had a lot of attention of late in this Chamber, so it is interesting to balance the two.
	There are more than 40 types of epilepsy. It covers an amazingly massive spectrum, not just the classic “grand mal” fit with which many associate it. It can be as simple as the occasional “absence”, when people lose their attention for some reason. Epilepsy is often the least noticeable of a range of complex conditions that an individual has. More than 42% of pupils with epilepsy are on the learning disability spectrum. For some people with very severe forms of conditions such as cerebral palsy, epilepsy is almost the least of their concerns, but it is still an ever-present part of their daily lives.
	A recent CHESS—Children with Epilepsy in Sussex Schools—study found that 42% of pupils with epilepsy were not fulfilling their potential in the school system, and I think that that important fact represents the crux of the debate. This is about not only the medical implications of epilepsy, but the societal context. So much is based on ignorance of the condition. That does not just mean not knowing what to do when someone is having a seizure; more important, it means ignorance of the causes, the background and the neurological underpinning of epilepsy, and, in an educational context, the implications for an individual’s learning capacity.
	Lurking behind all that are the consequences of prejudice and the stigma that is attached to epilepsy. I often cite one example of that. When I was a Conservative candidate in Twickenham, I wrote to my local paper about national epilepsy day in an attempt to raise awareness of the condition. I was shocked when, the following week, a constituent wrote, “Mr Maynard should not have to worry; he has merely been possessed by evil spirits.” At the time I found it hard to believe that such a level of prejudice could exist, and I find it just as hard to believe now. However, it occurs not just in the playground, but in the classroom. Many
	pupils with epilepsy report a lack of understanding on the part of members of staff, which I think needs to be tackled.
	The Children and Families Act represents a major opportunity in that regard. It has numerous good aspects, but I must ask the Minister a fundamental question: how can he ensure, as he implements the Act, that the needs of children with epilepsy are not left by the wayside just because they are among the more complex needs in terms of both health and education? I am sure the Minister agrees that the challenge posed by the Act will not simply disappear following Royal Assent. If anything, the challenge of implementation is that much greater. I ask him to bear it in mind that, as I said earlier, 42% of pupils fail to fulfil their educational potential. I should welcome his thoughts about how we can ensure that that percentage is reduced.
	As I have said, I think that the Children and Families Act contains much that is good. I welcome the fact that school governors will have a duty to address the medical needs of pupils who are in their care. I welcome the fact that we are moving towards a more practical acceptance of epilepsy in the classroom. A couple of months ago, the Minister and I were lucky enough to launch the Council for Disabled Children’s “Dignity and Inclusion” documents, which provide teachers with a practical way in which to assess how to deal with children with epilepsy in their classrooms. However, I think that there is still more to be done.
	I myself have nocturnal epilepsy. I have night-time fits, which are triggered by alcohol. When I come to the next morning, my short-term memory is gone. I struggle to remember what I did the day before. I would probably even struggle, initially, to answer that classic question, “Can you name the Prime Minister?” I would have to think long and hard about it, and might actually fail to answer it, although I assure the House that I could answer it now.
	It must be borne in mind that epileptic attacks, seizures and fits all have consequences for pupils’ learning. Young Epilepsy, the major charity that campaigns on behalf of people with epilepsy, which has been a great help in putting together the information for the debate, has produced what it calls “A Manifesto for Change”, which contains some useful guidance on matters on which I should like the Minister to focus. First and foremost, it wants to ensure that all pupils have access to a high-quality personalised assessment of their needs, rather than being subject to a standard tick-box approach. I know that Young Epilepsy has a graph assessment tool called ABLE, which may be helpful in that regard. It is all very well having an assessment and determining needs, but one must go to the next stage. All pupils, parents and teachers need to understand what the entitlements are as a consequence of the assessment. There is no point being assessed and then not knowing what one is entitled to and what the local offer consists of.
	The third aspect that Young Epilepsy is campaigning on is perhaps the trickiest: teacher training. I realise that central Government have little control, if any, over the composition of teacher training syllabuses, but the key point that it is not just about the first aid aspects of dealing with a pupil with epilepsy, important though that is—it often seems to get the main focus in political debate; it is also about understanding the consequences
	for an individual’s learning of those epilepsy seizures. More important again, it is about trying to understand that knowing how to spot the warning signs can incentivise earlier diagnosis and better care for the pupil.
	I would welcome the Minister’s view on what he can do to encourage a greater role for epilepsy in initial teacher training. What can we do as part of continuous professional development to incentivise teachers who have already been trained and are in the classroom to look at epilepsy and understand not just the first aid consequences but the learning consequences? The two go hand in hand.
	Another aspect that is worth bearing in mind and on which I would welcome the Minister’s view is the assessment that he has made of the pathfinders that have been reviewed recently. I understand that one of the initial conclusions is that within the existing resource allocation, it has been very hard to make a real difference to the lives of individual families. I know that that is an initial finding. Does he share that view? Does he have an alternative opinion?
	I understand that £70 million has been allocated across the country to a range of local councils, which have all spent that money differently. Some have spent it on improving data systems, others on improving the local offer. Others have hired extra staff. How will the Minister assess all these different funding streams? What has had the most impact on families and the children? How will he measure the effectiveness of the £70 million? It is good to have £70 million, but we need to know how local authorities can best spend it.
	Equally welcome is the £30 million that will go into what will be called independent supporters. That term seems a bit nebulous. I am not sure I can give a precise definition on the Floor of the House. I would welcome a bit more information from the Minister on what that might involve.
	I would also like some reassurance. There is a slight concern in the epilepsy community that the £30 million may go to the larger charities, which can spend their money on branding, rather than investing in service delivery, expertise and competency down the years. It would be a great tragedy if the expertise were not utilised to ensure continuity of care for pupils between home, school and any other setting. That is why it is worth paying tribute once again to the Minister for his determination to ensure that we have education, health and care plans. I know that that was a running sore throughout the development and legislative process of the Act. We had to try to meld education and health, which did not always fit together neatly. It is vital that we have education, health and care plans, which will allow pupils to fit in between the two.
	The other question I have for the Minister relates to the role of Ofsted. How will it assess the quality of the provision? At the moment I understand that we can rely on parent satisfaction surveys as a key indicator of whether services are working well. Although those are not to be dismissed, I am not sure that they constitute a proper statistical basis on which to make evidence-based policy decisions. I know that the Government are strong believers in an outcome-based system and in assessing the effectiveness of legislative intervention, but in this specific instance what outcomes will be used to make
	that assessment? Who will be doing the assessing—Ofsted or some other body? Will they have sufficient powers to assess the health component of what will occur in the educational setting as well as the educational activities?
	My final question relates to what are called key workers, which is a relatively broad term and encompasses people who truly understand epilepsy and who can help families to navigate their way through what remains a complex minefield of different service providers. It is noted in the Children and Families Act that key workers are seen to be a good thing, but they are not mandatory: they are merely an advised addition that local authorities can consider. I would be interested to know how the Minister thinks we can strengthen the appeal of key workers, though not necessarily to make them mandatory, because I understand the importance of localism and ensuring that local authorities make up their own minds. There is a case, however, for ensuring that key workers do not become a luxury optional extra that gets tacked on at the end of a local offer if there is some money left over, but are the building blocks of the local offer provision for families with children with epilepsy.
	I realise that, as is the nature of Adjournment debates, I have peppered the Minister with detailed questions, some of which I hope he can answer—civil servants in the Box are passing yet more answers to him as I speak. If he cannot answer all my questions, I hope he will be able to write to me at a later date. I thank him for agreeing to meet Young Epilepsy, which I am sure will be an interesting meeting in the light of this debate. I thank him and all hon. Members who have attended for their time, and I look forward to hearing his reply.

Edward Timpson: May I begin in the traditional and in this case very pertinent way, by congratulating my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) for once again initiating an important debate about the wide subject of special educational needs and the specific area of those many children and young people who have some form of epilepsy? This is not the first debate of this kind that we have had, and it is good that he reminds us that as we move on from the statute book to the implementation of the Children and Families Act 2014, we should keep our focus very much on what this means to the families and children who we hope to benefit from the reforms.
	Like my hon. Friend, I understand the importance of supporting pupils with medical conditions such as epilepsy, and it is imperative that the right support is put in place quickly and effectively. I will try to cover as many of the points that he made as possible, and I will of course endeavour to make sure he has a full and proper response in writing to those that I do not.
	I should like to start by restating our ambition that every child with SEN, or who has a disability or a medical condition that impedes their ability to learn, including those with epilepsy, receives the support they need, so they can achieve well in school and go on to find employment and lead happy and fulfilled lives. The special needs reforms in the 2014 Act are deliberately focused on joining up help across education, health and social care, so that children receive the help that they need when they need it throughout their education.
	Parents and children will be involved in decisions about the support they receive much more closely than hitherto, so that they have a genuine say in what they want to achieve and how they will achieve it.
	Epilepsy is just one of the many medical conditions for which pupils require support, to help them progress properly through school, and it is right to acknowledge the excellent work that most of our schools do to provide the support that their pupils need. However, there can be no excuse for the poor practice that evidence suggests exists in some schools.
	Under the Equality Act 2010, schools have clear duties not to directly or indirectly discriminate against children and young people with disabilities. Government guidance on the Act clearly identifies long-term health conditions, such as epilepsy, as being among the impairments from which a disability can arise, and they are therefore covered by this duty. As such, this form of discrimination is simply not acceptable.
	As my hon. Friend skilfully argued, however, pupils with epilepsy often face significant challenges and difficulties not just in school, but in all aspects of their lives, and I also recognise that these challenges can be exacerbated because of a lack of understanding of the condition by others.
	I remember a family holiday from about 30 years ago when we had with us a school friend of my sister who had epilepsy, unbeknown to me. During our holiday, this child, who sadly and tragically died this year, suffered an epileptic fit. As a young boy, I was shocked by what I saw happen in front of my eyes, but, having had had it explained to me, it has left me in good stead for the rest of my life, in terms of understanding the cause, effect and manifestation of epilepsy and the surrounding context for someone who has it. That was pure chance, and many people, whether pupils or even teachers at school, do not have that experience and cannot draw from it.
	As my hon. Friend said, that is one reason why we introduced a new duty for school governing bodies to make arrangements to support pupils with medical conditions and to have regard to guidance, so that they get the support they need at their time of need. Our aim in putting that duty in the 2014 Act was to send out a clear message that poor practice will not be tolerated and that conditions such as epilepsy must be properly recognised. Pupils with medical conditions deserve to be supported properly in schools and to have the same chances as everyone else to succeed in whatever they choose to do.
	The new statutory guidance on supporting pupils with medical conditions acknowledges the negative social and emotional implications associated with medical conditions such as epilepsy. That is why there is a clear expectation for a child’s social and emotional needs to be taken into account when considering the support that they require. This guidance, which comes into force in September, is deliberately child-focused, recognising that medical conditions will present differently in different children. Epilepsy is a case in point; no two children with epilepsy will have identical needs, and it is therefore right, as my hon. Friend said, that each case is treated individually, based on the needs of each child.
	That is why we have also made it clear in the guidance that the school’s policy should cover the role of individual health care plans and clearly state who is responsible for
	their development. The plans will help to ensure that school staff know how to support pupils in lessons, how to help them with administering medication and what to do in an emergency. They will be drawn up in collaboration between the school, the parents and the pupil—that is important—and the most relevant health care professional, such as the epilepsy specialist nurse. I am pleased that we have developed the new statutory guidance in such close collaboration with a wide range of interested parties. Young Epilepsy, as a member of the Health Conditions in Schools Alliance, was actively involved in that work and added substantial value to the guidance, for which we are extremely grateful.
	In identifying children and young people who need additional support and adjustments, whether because they have a health condition, a disability or special educational needs, the key is that professionals should look at the particular needs of the individual and seek to co-ordinate support, so all these needs are addressed coherently. Children with epilepsy will not necessarily have SEN. What is set out in a child’s individual health care plan might be enough to ensure that he or she has access to differentiated, high-quality teaching. However, where a child has SEN, the new nought-to-25 SEND—special educational needs and disability—code of practice sets out how schools should work with parents to identify underlying issues, including health needs, and reflect those in the support given and the outcomes we all want to see achieved. Where a child or young person has an education, health and care plan, the code sets out a thorough process—again, with parents centrally involved—for putting in place a comprehensive plan covering the full range of a child’s needs; obviously, that can include support provided by specialist services.
	These plans are also supported by the strategic arrangements in the 2014 Act. The joint commissioning duties require education, care and health services to come together to commission services for children and young people with SEN and disabilities. Wider provision is also covered, including through a consideration of how to integrate education, health and care provision to provide that most effectively, in line with wider duties. As my hon. Friend will also be aware, the new local offer will set out details of all the services for children and young people with SEN and disabilities in a local authority area and how to access them. We expect that that will reflect the full range of services, including those for children and young people with epilepsy, and those offered by the voluntary and community sector.
	On initial teacher training, I fully understand the case my hon. Friend makes, and it is always tempting to look to ITT as a solution in respect of the desire to see every teacher well versed in the practice of dealing with many of these conditions. Teaching standards include duties on schools to ensure that their staff understand how to deal with children’s special educational needs. We can also look at reviews into initial teacher training to satisfy ourselves that they are going far enough.
	My hon. Friend will know that there have been a number of evaluations of pathfinders in 31 local authority areas. We now have pathfinder champions who are helping those non-pathfinder areas to learn from the evaluation of the progress that they have made. We have excellent examples of families who feel that the culture has shifted. For the first time, they have been able to sit in a room with someone from education, someone from
	health and someone from social care, and they have been asked what they think should happen, rather than it being told to them.
	The special educational needs reform grant of £70 million has gone to local authorities. We have done a local authority readiness test to see how each local authority is performing in preparation for the changes in September. Ofsted is doing some thematic work to look at how some of the reforms will bed in over the next months and years, and I hope to see progress in time towards a more cohesive inspection regime of special educational need provision across all the different services. Ofsted is starting to consider that that is the best way forward for children’s services, and there is a good case for looking more carefully at how education, health and social care inspection can be brought together, so that it looks at the experience of the child and the family, rather than at the individual services.
	The independent supporters are, in many ways, the key workers about whom my hon. Friend was talking. The £30 million will pay for 1,800 independent supporters who will be drawn predominantly from the charitable sector. I encourage organisations such as Young Epilepsy, which want to get involved, to contact the Council for Disabled Children, which is helping us to recruit those independent supporters. It works out at about 12 in each local authority area. We know from speaking to parents right across the country that one of the things
	that they value more than anything else is to have someone who is not from the local authority, the school or one of the health providers to provide them with that genuine independent support to navigate them through what can sometimes be seen as a very convoluted system—a system that we are trying to make clearer and easier to access. It is very much an investment in service delivery, as my hon. Friend says, and the £30 million will be invested over the next two years. To monitor its progress, we will work closely with our strategic partner, the Council for Disabled Children, to make sure that it is having the impact that we all want to see.
	Over and above that, I will be saying more tomorrow about how we will ensure that the extra burdens that we are placing on local authorities will be met, so that the authorities have sufficient funds to ensure that the system really does reach the parts that we want it to. Ultimately, this is about ensuring that parents and young people who have special educational needs and disabilities see that cultural change in the system that for too long has been absent. As my hon. Friend says, this is a fork in the road, and we need to take the right path. I believe that we can do that, but we need to pull together to make sure that this really does make the difference that we all want to see.
	Question put and agreed to.
	House adjourned.